| NPI | 1235979089 |
|---|---|
| Former Name | BREEANNA CAROL FLUCKEY |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: OK 0783R) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| Enumeration Date | 2024-05-29 |
| Last Update Date | 2024-06-29 |