NPI | 1720241482 |
---|---|
Former Name | KRYSTAL MARIE GENNARIA |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CA 16548) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 567327) |
Enumeration Date | 2008-07-02 |
Last Update Date | 2008-07-02 |