NPI | 1518507193 |
---|---|
Former Name | SAMANTHA LEE DERRINGER |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: KY 3014150) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: KY 3014150) |
Enumeration Date | 2020-01-10 |
Last Update Date | 2022-05-20 |