NPI | 1508266842 |
---|---|
Former Name | SANDIE JEAN |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CT 005821) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: CT 5821) |
Enumeration Date | 2014-08-22 |
Last Update Date | 2018-06-27 |