| NPI | 1548893472 |
|---|---|
| Former Name | CAROLINE KELLY BACON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner Adult Health (Licence: TN 27189) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner Acute Care (Licence: TN 27189) |
| Enumeration Date | 2020-02-19 |
| Last Update Date | 2023-07-19 |