| NPI | 1619242674 |
|---|---|
| Other Name | CAROLINE BLAKE ELLENBURG |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: AL 1-120527) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TN 15875) |
| Enumeration Date | 2012-03-09 |
| Last Update Date | 2015-03-23 |