NPI | 1568718336 |
---|---|
Former Name | NANCI SULLIVAN BLACKERT |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NC 5005832) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NC F0512372) |
Enumeration Date | 2012-07-31 |
Last Update Date | 2016-08-11 |