NPI | 1538744362 |
---|---|
Former Name | CARLITA LEIGH DOMINGUEZ |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NH 112310-23) |
Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: FL APRN11019350) |
363L00000X Nurse Practitioner (Licence: MA RN2309117) | |
Enumeration Date | 2021-03-12 |
Last Update Date | 2024-10-03 |