NPI | 1487147369 |
---|---|
Former Name | DONNA SMITH |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MO 2023041356) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: VA 0024176194) |
Enumeration Date | 2018-06-14 |
Last Update Date | 2024-05-31 |