| NPI | 1245877620 |
|---|---|
| Former Name | SALLI SLACK |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MO 2019045212) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MO 2019045212) |
| Enumeration Date | 2019-12-05 |
| Last Update Date | 2025-07-29 |