| NPI | 1538827985 |
|---|---|
| Former Name | NICOLE MATEO LICUP |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner Primary Care (Licence: CA 95015421) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 95085049) |
| Enumeration Date | 2021-12-02 |
| Last Update Date | 2022-02-08 |