| NPI | 1316379324 |
|---|---|
| Former Name | THERESA A LASELVA |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: KY 3007914) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: KY 1104439) |
| Enumeration Date | 2013-07-31 |
| Last Update Date | 2014-12-04 |