| NPI | 1619590205 |
|---|---|
| Former Name | KATELYN RHEA MAXWELL |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MO 2020013110) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: IL 209021289) |
| Enumeration Date | 2020-05-18 |
| Last Update Date | 2021-08-09 |