| NPI | 1508326372 |
|---|---|
| Former Name | GINA PHILLIPS |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 77199-20) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: CO TL.0007490) |
| Enumeration Date | 2019-03-20 |
| Last Update Date | 2022-08-04 |