NPI | 1669093175 |
---|---|
Former Name | LACEY RENEE GROFF |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: WI 10419-33) |
Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
Enumeration Date | 2020-05-06 |
Last Update Date | 2023-10-27 |