| NPI | 1437493228 |
|---|---|
| Former Name | TINA STIDHAM |
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: KY 3007764) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: KY 3007764) |
| Enumeration Date | 2012-11-16 |
| Last Update Date | 2013-10-03 |