| NPI | 1598377319 |
|---|---|
| Former Name | RENEE SHAWNTA GREEN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: GA Rn228608) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA RN228608) |
| 363L00000X Nurse Practitioner (Licence: GA RN228608) | |
| Enumeration Date | 2020-08-21 |
| Last Update Date | 2022-07-07 |