| NPI | 1629378401 |
|---|---|
| Former Name | DONITA MCDIFFETT |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner Adult Health (Licence: MO 2011001350) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner Adult Health (Licence: KS 53-75237-102) |
| 363LF0000X Nurse Practitioner Family (Licence: MO 2011001350) | |
| 363LF0000X Nurse Practitioner Family (Licence: KS 5375237102) | |
| Enumeration Date | 2010-10-27 |
| Last Update Date | 2019-08-02 |