NPI | 1457438467 |
---|---|
Former Name | BETHANNE WILLIS |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363LP0200X Nurse Practitioner Pediatrics (Licence: IN 71001903) |
Additional Taxonomies | 363LP0200X Nurse Practitioner Pediatrics (Licence: IN 28106651) |
Enumeration Date | 2006-11-01 |
Last Update Date | 2023-12-05 |