| NPI | 1336713213 |
|---|---|
| Former Name | RANDEE KATHRYN WALCK |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OK 38438) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| Enumeration Date | 2021-05-17 |
| Last Update Date | 2025-02-05 |