| NPI | 1508859984 |
|---|---|
| Former Name | COLLEEN ANN KING |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MD R201512) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MD r201512) |
| 2255A2300X Specialist/Technologist, Athletic Trainer | |
| Enumeration Date | 2005-08-31 |
| Last Update Date | 2023-02-14 |