NPI | 1578120085 |
---|---|
Former Name | SAMANTHA BERNENS |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics (Licence: MN 6633) |
Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
Enumeration Date | 2019-05-21 |
Last Update Date | 2019-06-14 |