NPI | 1629510623 |
---|---|
Former Name | SAMANTHA RYAN JUDD |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MI 4704284681) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MD AC002090) |
363LP0200X Nurse Practitioner, Pediatrics (Licence: MD ac001428) | |
363LP0200X Nurse Practitioner, Pediatrics (Licence: VA 0024172146) | |
Enumeration Date | 2016-11-08 |
Last Update Date | 2024-01-31 |