| NPI | 1720194939 |
|---|---|
| Former Name | ANNA HAZEL TIELSCH-GODDARD |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics (Licence: CT 3291) |
| Additional Taxonomies | 363LP0200X Nurse Practitioner, Pediatrics (Licence: TX 765853) |
| 163W00000X Registered Nurse (Licence: CT 73362) | |
| Enumeration Date | 2006-08-21 |
| Last Update Date | 2016-04-05 |