NPI | 1710507264 |
---|---|
Former Name | BRANDI ASHTON STANBACK |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LW0102X Nurse Practitioner, Women's Health (Licence: KY 3017181) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: KY 1158085) |
Enumeration Date | 2020-04-24 |
Last Update Date | 2024-12-02 |