NPI | 1659733731 |
---|---|
Former Name | TERA GERICKE |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NM 54686) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MO 2016009388) |
363LF0000X Nurse Practitioner, Family (Licence: KS 53-77233-122) | |
Enumeration Date | 2016-03-28 |
Last Update Date | 2022-02-10 |