NPI | 1508321431 |
---|---|
Former Name | KATELYN ELLEN UTENDORF |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: OH APRN.CNP.024011) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: OH RN.415162) |
Enumeration Date | 2019-02-05 |
Last Update Date | 2020-03-29 |