| NPI | 1619432705 |
|---|---|
| Former Name | ELAINE MARIE WAGUESPACK |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: LA AP10134) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: LA AP10134) |
| Enumeration Date | 2019-02-04 |
| Last Update Date | 2020-12-09 |