| NPI | 1558676536 |
|---|---|
| Former Name | ANGELA IRENE POULOS |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: WI 4352) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: WI 153545) |
| 363L00000X Nurse Practitioner (Licence: WI 4352-33) | |
| 163W00000X Registered Nurse (Licence: WI 153545-30) | |
| Enumeration Date | 2010-08-13 |
| Last Update Date | 2015-05-07 |