NPI | 1346734720 |
---|---|
Former Name | KATELYN DIANA ANDERSON |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TN 23934) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: GA GAA-NP002185) |
Enumeration Date | 2018-06-19 |
Last Update Date | 2024-06-05 |