NPI | 1518520238 |
---|---|
Former Name | MALLORY BROOKE DOTSON |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NC 5011691) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NC 5011691) |
Enumeration Date | 2019-04-18 |
Last Update Date | 2024-06-25 |