| NPI | 1245347657 |
|---|---|
| Former Name | IDA CAMPBELL GONZALEZ |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: WA AP30003481) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: OR 200650038NP) |
| Enumeration Date | 2006-08-23 |
| Last Update Date | 2014-09-10 |