| NPI | 1497258297 |
|---|---|
| Former Name | LACEY NOEL RUPPERT |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 34.015896) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| Enumeration Date | 2018-03-18 |
| Last Update Date | 2022-08-09 |