| NPI | 1598031122 |
|---|---|
| Former Name | LATOYA DENISE PHILLIPS |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: LA 307098) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OK 5874) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: GA 3990200000x) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: OK 5874) | |
| Enumeration Date | 2012-03-28 |
| Last Update Date | 2020-01-29 |