NPI | 1679047146 |
---|---|
Former Name | KELLEY PETERS |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: TN 25362) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN 205390) |
363LF0000X Nurse Practitioner Family (Licence: TN 25362) | |
Enumeration Date | 2019-01-17 |
Last Update Date | 2022-07-13 |