| NPI | 1598059586 |
|---|---|
| Former Name | NICOLE LYNN GERGEN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA C196387) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: RI LP02344) |
| 207R00000X Internal Medicine (Licence: MI 4301107537) | |
| 208000000X Pediatrics (Licence: MI 4301107537) | |
| 208000000X Pediatrics (Licence: RI LP02344) | |
| Enumeration Date | 2011-06-07 |
| Last Update Date | 2024-09-25 |