| NPI | 1548941107 |
|---|---|
| Former Name | IVANA SHALONDA MARTIN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: SC 27775) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: SC 240441) |
| Enumeration Date | 2023-07-27 |
| Last Update Date | 2025-02-25 |