| NPI | 1356768220 |
|---|---|
| Former Name | KELLY NICOLE WEPKING |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 66313-20) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2014-03-27 |
| Last Update Date | 2021-01-19 |