| NPI | 1275055493 |
|---|---|
| Former Name | ELIZABETH DIANE SPENCER |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MO 2017017448) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: KS 77733) |
| Enumeration Date | 2017-07-10 |
| Last Update Date | 2017-07-11 |