NPI | 1720616873 |
---|---|
Former Name | STEPHANIE ANN BURNHAM |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: VA 0024179867) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: VA 0001244829) |
Enumeration Date | 2020-04-01 |
Last Update Date | 2021-12-21 |