NPI | 1609303320 |
---|---|
Former Name | BRIANNE C EVENSON |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IL 277.000755) |
Additional Taxonomies | 207QA0401X Family Medicine, Addiction Medicine (Licence: IL 277.000755) |
363LF0000X Nurse Practitioner, Family (Licence: IL 209.015961) | |
Enumeration Date | 2017-05-11 |
Last Update Date | 2021-04-09 |