NPI | 1649636101 |
---|---|
Former Name | STACIE RILEY |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: DE LG-0000905) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: DE L1-0036765) |
Enumeration Date | 2016-01-13 |
Last Update Date | 2016-01-13 |