| 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 | 2025-08-25 |