NPI | 1508050824 |
---|---|
Former Name | PAMELA LYNN SEALOCK |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: WI 3343) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: IL 209.006724) |
Enumeration Date | 2007-08-29 |
Last Update Date | 2024-02-19 |