NPI | 1609411685 |
---|---|
Former Name | OLEAHA MASON |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IL 209018792) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: IL 041373011) |
Enumeration Date | 2019-11-13 |
Last Update Date | 2023-04-04 |