NPI | 1336413392 |
---|---|
Former Name | MARIE SMITH |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: KS 53-75707-022) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MO 2012007177) |
Enumeration Date | 2012-03-08 |
Last Update Date | 2024-02-04 |