| NPI | 1659141174 |
|---|---|
| Former Name | KRISTA VAN DYK |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MT NUR-APRN-LIC-233853) |
| Enumeration Date | 2024-01-05 |
| Last Update Date | 2024-02-10 |