NPI | 1427607308 |
---|---|
Former Name | CAEDORA MARYLOUISE GARDNER |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NC 5012193) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: NC 264004) |
363LF0000X Nurse Practitioner, Family (Licence: NC 5012193) | |
363LF0000X Nurse Practitioner, Family (Licence: VA 0024183725) | |
Enumeration Date | 2019-09-04 |
Last Update Date | 2025-04-08 |