| NPI | 1457934648 |
|---|---|
| Former Name | ELLEN J DOUGLASS |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ID O-1753) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ID MRO-2047) |
| Enumeration Date | 2021-05-04 |
| Last Update Date | 2024-07-01 |