NPI | 1356887053 |
---|---|
Former Name | BRANDIE SHANDELLE CAROLINA |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: GA RN221736) |
Enumeration Date | 2017-01-18 |
Last Update Date | 2024-04-16 |