| NPI | 1437563376 |
|---|---|
| Former Name | STEPHANIE JOHNIECE WILBURN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NH 24095) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OK 30753) |
| Enumeration Date | 2014-06-18 |
| Last Update Date | 2023-06-08 |