NPI | 1588198246 |
---|---|
Former Name | CHANEY MARIE ROBERTS |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MO 2017002553) |
Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: IL 209015346) |
Enumeration Date | 2017-04-19 |
Last Update Date | 2023-02-03 |