| NPI | 1396100566 |
|---|---|
| Former Name | JOHANNA THEODOSIA CROCK |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: CO APN.0992159-NP) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: CO APN.0992159-NP) |
| Enumeration Date | 2015-12-15 |
| Last Update Date | 2018-10-16 |