| NPI | 1417526864 |
|---|---|
| Former Name | SAMANTHA CRISMON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: UT 5942923-4405) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: UT 5942923-3102) |
| Enumeration Date | 2021-06-21 |
| Last Update Date | 2022-07-12 |