| NPI | 1285199679 |
|---|---|
| Former Name | KELSEY MARIE BIVACCA |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: IL 277-002417) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TN 25469) |
| 363LF0000X Nurse Practitioner, Family (Licence: IL 277-002417) | |
| 363LF0000X Nurse Practitioner, Family (Licence: FL 11001380) | |
| Enumeration Date | 2019-02-10 |
| Last Update Date | 2024-08-22 |