NPI | 1497461990 |
---|---|
Former Name | KELLY RAE NORTHWAY |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MN 9891) |
Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MN 302580) |
Enumeration Date | 2023-01-27 |
Last Update Date | 2023-01-27 |