| NPI | 1376550137 |
|---|---|
| Former Name | THERESA LEE CLANTON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 246RP1900X Technician, Pathology Phlebotomy (Licence: MO 475-1) |
| Additional Taxonomies | 376K00000X Nurse's Aide |
| Enumeration Date | 2006-08-02 |
| Last Update Date | 2019-01-28 |