NPI | 1487654257 |
---|---|
Former Name | CATHERINE W KELLY |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: WA AP30005002) |
Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: OR 201709500) |
363L00000X Nurse Practitioner (Licence: MT 132563) | |
Enumeration Date | 2005-07-22 |
Last Update Date | 2020-10-07 |