NPI | 1467916148 |
---|---|
Former Name | STACY MARIE REEVES |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: MD R201835) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: MD R201835) |
Enumeration Date | 2019-01-26 |
Last Update Date | 2019-01-26 |