| NPI | 1588257133 |
|---|---|
| Former Name | LIDUVINA ISABEL PORTILLO |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: KY 3015158) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: KY 3015158) |
| Enumeration Date | 2021-02-15 |
| Last Update Date | 2024-03-28 |