NPI | 1285062638 |
---|---|
Former Name | GRETCHANN ELIZABETH FONDREN |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics (Licence: OH 15291) |
Additional Taxonomies | 163WP0200X Registered Nurse, Pediatrics (Licence: OH 318343) |
Enumeration Date | 2013-10-23 |
Last Update Date | 2022-03-11 |