| NPI | 1275301327 |
|---|---|
| Former Name | NICOLE ELISE RUSSELL |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 164W00000X Licensed Practical Nurse (Licence: ID 67327) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: OR 201911198LPN) |
| Enumeration Date | 2023-12-18 |
| Last Update Date | 2023-12-18 |