| NPI | 1275793358 |
|---|---|
| Former Name | ANGELA RENEE PREVATT |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207YP0228X Otolaryngology, Pediatric Otolaryngology (Licence: FL ME115569) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| Enumeration Date | 2008-06-12 |
| Last Update Date | 2014-09-16 |