| NPI | 1699252452 |
|---|---|
| Former Name | HOLLY ELLEN MARIETTA |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LW0102X Nurse Practitioner Women's Health (Licence: AZ AP11555) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: AZ AP11555) |
| 207VE0102X Obstetrics & Gynecology Reproductive Endocrinology (Licence: AZ AP11555) | |
| Enumeration Date | 2018-07-25 |
| Last Update Date | 2023-08-10 |