NPI | 1366100802 |
---|---|
Former Name | EMILY CLARK WALLACE |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: VA 0024188752) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: VA 0001270316) |
Enumeration Date | 2021-12-01 |
Last Update Date | 2023-12-21 |