| NPI | 1699418822 |
|---|---|
| Former Name | LIA MICHELLE KENYON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NC 5021022) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NC UQMI1VS2) |
| Enumeration Date | 2022-04-15 |
| Last Update Date | 2024-11-05 |