NPI | 1518730449 |
---|---|
Former Name | AMY MARLENE HOUSTON |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MO 2023035576) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: MO 2019025605) |
Enumeration Date | 2023-11-02 |
Last Update Date | 2024-06-28 |