| NPI | 1619374808 |
|---|---|
| Former Name | BETHANY CAROL PAVON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MI 4704266187) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MI 4704266187) |
| Enumeration Date | 2014-12-03 |
| Last Update Date | 2024-10-07 |