NPI | 1457750234 |
---|---|
Former Name | SMANTHA BURNHAM |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics (Licence: VT 101.0134299) |
Additional Taxonomies | 363LP0200X Nurse Practitioner, Pediatrics (Licence: NY F382385-1) |
363LP0200X Nurse Practitioner, Pediatrics (Licence: NH 088196-23) | |
Enumeration Date | 2014-08-18 |
Last Update Date | 2023-10-23 |