| NPI | 1376765214 |
|---|---|
| Former Name | NICHOLE JEANETTE PRIDEMORE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: GA 000000) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: OH 303269) |
| 363LF0000X Nurse Practitioner, Family (Licence: MI 4704271769) | |
| Enumeration Date | 2007-05-02 |
| Last Update Date | 2023-06-05 |