NPI | 1487115614 |
---|---|
Former Name | KELSEY LEIGH LOFGREN |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics (Licence: GA 250178) |
Additional Taxonomies | 208000000X Pediatrics (Licence: SC 25413) |
Enumeration Date | 2019-03-29 |
Last Update Date | 2022-03-31 |