| NPI | 1639909567 |
|---|---|
| Former Name | CHARLOT K MAIN/STALLONE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: AK 227048) |
| Enumeration Date | 2024-08-06 |
| Last Update Date | 2024-08-24 |