| NPI | 1487197844 |
|---|---|
| Former Name | COLLEEN SHAE CUSICK |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics (Licence: AL 1-143175) |
| Additional Taxonomies | 363LP0200X Nurse Practitioner, Pediatrics (Licence: SC 20528) |
| Enumeration Date | 2016-12-02 |
| Last Update Date | 2021-04-14 |