NPI | 1295118610 |
---|---|
Former Name | MARIE WYDRA |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CO APN.100515-NP) |
Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: WA AP60571443) |
363L00000X Nurse Practitioner (Licence: IL 209012723) | |
Enumeration Date | 2015-07-02 |
Last Update Date | 2025-02-14 |