| NPI | 1467299727 |
|---|---|
| Former Name | ILENE NICOLE DIAZ |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX 1170306) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| Enumeration Date | 2024-07-12 |
| Last Update Date | 2024-08-01 |