| NPI | 1548503667 |
|---|---|
| Former Name | REBECCA DIVERS |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX R6744) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 207Q00000X Family Medicine (Licence: PA MD457153) | |
| Enumeration Date | 2013-03-27 |
| Last Update Date | 2021-11-01 |