NPI | 1467826693 |
---|---|
Former Name | CRYSTAL LISE TAVERAS |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: RI APRN00778) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: CT 10730) |
Enumeration Date | 2015-11-27 |
Last Update Date | 2024-06-11 |