NPI | 1588042915 |
---|---|
Former Name | STEPHANIE LYNN BOLLES |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MN 3904) |
Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
Enumeration Date | 2015-05-18 |
Last Update Date | 2020-10-06 |