| NPI | 1629395868 |
|---|---|
| Former Name | ANNAMMA KOOTUMKAL CHACKO |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: IL 209.007801041.251125) |
| Enumeration Date | 2010-04-28 |
| Last Update Date | 2021-04-27 |