NPI | 1366731739 |
---|---|
Former Name | HOLLY SUE MATA |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 163WP0808X Registered Nurse, Psych/Mental Health (Licence: AZ RN147845) |
Additional Taxonomies | 163WR0400X Registered Nurse, Rehabilitation (Licence: PA TLRN035206) |
Enumeration Date | 2011-04-06 |
Last Update Date | 2024-09-06 |