NPI | 1316671449 |
---|---|
Former Name | DEVYN ROCHELLE DICKSON |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics (Licence: NY 383412) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: NY 383412) |
Enumeration Date | 2022-07-14 |
Last Update Date | 2023-07-22 |