| NPI | 1508095399 |
|---|---|
| Former Name | CARLA KAY MCCORMICK |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: NY 305178) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 5229711) |
| Enumeration Date | 2009-07-14 |
| Last Update Date | 2009-07-16 |