| NPI | 1700405859 |
|---|---|
| Former Name | DEANNAH MARIE DICK |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: VA 0101278658) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| Enumeration Date | 2020-04-09 |
| Last Update Date | 2023-06-12 |