NPI | 1568120574 |
---|---|
Former Name | KELSEY ELIZABETH BONNER |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: MD R222605) |
Additional Taxonomies | 207QA0505X Family Medicine, Adult Medicine (Licence: MD R222605) |
Enumeration Date | 2021-12-07 |
Last Update Date | 2024-11-22 |