| NPI | 1356690267 |
|---|---|
| Former Name | JOANNE MARIE MICKLEBOROUGH |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics (Licence: IL 209006567) |
| Enumeration Date | 2012-09-06 |
| Last Update Date | 2022-09-11 |