| NPI | 1265910475 |
|---|---|
| Former Name | CARLY MEGAN LOUDERBACK |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: GA F07180027) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: GA RN277403) |
| Enumeration Date | 2018-07-31 |
| Last Update Date | 2025-10-09 |