| NPI | 1548338619 |
|---|---|
| Former Name | CHANTE MONIQUE ELLISON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX Q1595) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 052351) |
| Enumeration Date | 2006-11-30 |
| Last Update Date | 2015-08-17 |