| NPI | 1457612467 |
|---|---|
| Former Name | KIERSTEN GRACE INGALLS |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NY 337405) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NY 22603193) |
| Enumeration Date | 2012-06-06 |
| Last Update Date | 2020-09-30 |