NPI | 1598044034 |
---|---|
Former Name | CRYSTAL RENEA BRANDON |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MI 4704213325) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11016360) |
Enumeration Date | 2011-08-16 |
Last Update Date | 2024-12-18 |