NPI | 1629645353 |
---|---|
Former Name | JORDAN MICHELLE LACY |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 1046041) |
Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 133644) |
Enumeration Date | 2021-06-10 |
Last Update Date | 2023-10-02 |