| NPI | 1538789896 |
|---|---|
| Former Name | NICOLE MARIE GOURNEAU |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: ND PT20122) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: SD 0527) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2020-04-16 |
| Last Update Date | 2023-08-10 |