NPI | 1710343157 |
---|---|
Former Name | YONGOR J KALEEWOUN |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: MN CNP 3830) |
Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: MN CNP 3830) |
363LG0600X Nurse Practitioner, Gerontology (Licence: MN CNP 3830) | |
Enumeration Date | 2016-01-14 |
Last Update Date | 2018-05-07 |