| NPI | 1417737172 |
|---|---|
| Former Name | EMILY CAROLINE HENSTROM |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LW0102X Nurse Practitioner, Women's Health (Licence: UT 11549817-4405) |
| Enumeration Date | 2023-10-02 |
| Last Update Date | 2024-12-30 |