| NPI | 1588067284 |
|---|---|
| Former Name | MICHELLE WANTA |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: FL APRN9387047) |
| Enumeration Date | 2014-10-08 |
| Last Update Date | 2022-02-17 |