| NPI | 1245939602 |
|---|---|
| Former Name | MICHELLE LEA TELLEZ |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NM 72598) |
| Additional Taxonomies | 163WP0808X Registered Nurse, Psych/Mental Health (Licence: NM R65710) |
| Enumeration Date | 2023-02-24 |
| Last Update Date | 2023-04-04 |