NPI | 1336505239 |
---|---|
Former Name | JULIANNE ELIZABETH TYLKO |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MA RN2303106) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: MA RN2303106) |
Enumeration Date | 2016-01-07 |
Last Update Date | 2019-04-10 |