NPI | 1548819477 |
---|---|
Former Name | CHRISTI LEA VENTRIS |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LA2200X Nurse Practitioner Adult Health (Licence: OK 109643) |
Additional Taxonomies | 261QU0200X Clinic/Center Urgent Care (Licence: OK 109643) |
Enumeration Date | 2019-09-04 |
Last Update Date | 2019-12-24 |