NPI | 1568793453 |
---|---|
Former Name | LORI FATLA |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: IL 209013770) |
Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: WI 3875) |
Enumeration Date | 2010-01-18 |
Last Update Date | 2024-01-17 |