NPI | 1518453331 |
---|---|
Former Name | KALEY GOODMAN |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL 9324622) |
Additional Taxonomies | 163WX0800X Registered Nurse, Orthopedic (Licence: FL 9324622) |
363L00000X Nurse Practitioner (Licence: FL 9324622) | |
Enumeration Date | 2018-07-04 |
Last Update Date | 2020-12-10 |