NPI | 1336385525 |
---|---|
Former Name | TANJA K RANDALL |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MO 2003016241) |
Additional Taxonomies | 163WW0000X Registered Nurse, Wound Care (Licence: MO 2003016241) |
Enumeration Date | 2008-12-18 |
Last Update Date | 2012-04-24 |