| NPI | 1275247199 |
|---|---|
| Former Name | CARISSA MARIE MAGGARD |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MT NUR-APRN-LIC-212012) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MT RN-190701) |
| Enumeration Date | 2023-01-06 |
| Last Update Date | 2024-08-15 |