NPI | 1336499904 |
---|---|
Former Name | NICOLE RAE TABATT |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MN 1207) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MN R 130266-8) |
Enumeration Date | 2012-09-11 |
Last Update Date | 2022-02-11 |