| NPI | 1457198517 |
|---|---|
| Former Name | MARY KATHERINE VIRGINIA ANDERSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TN 36669) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN 250845) |
| Enumeration Date | 2024-07-15 |
| Last Update Date | 2024-07-24 |