NPI | 1578030334 |
---|---|
Former Name | SHELBY IRENE DEWITT |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11031162) |
Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: MI 4704249824) |
Enumeration Date | 2018-10-30 |
Last Update Date | 2025-06-06 |