NPI | 1497201107 |
---|---|
Former Name | CASEY JEAN CLARDY |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: WI 7170-33) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: WI 189789) |
Enumeration Date | 2016-09-01 |
Last Update Date | 2021-12-07 |