| NPI | 1598399461 |
|---|---|
| Former Name | ELYSE LYN GROGAN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: IN 71010471A) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: IN 28206959A) |
| 363LF0000X Nurse Practitioner, Family (Licence: IN 71010471A) | |
| Enumeration Date | 2020-02-28 |
| Last Update Date | 2024-02-06 |