NPI | 1437526894 |
---|---|
Former Name | KELLI S VICEK |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: AK 133545) |
Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: LA 227339) |
363LF0000X Nurse Practitioner, Family (Licence: OR 201506440NP-PP) | |
Enumeration Date | 2015-09-01 |
Last Update Date | 2025-04-23 |