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 |