NPI | 1730432493 |
---|---|
Former Name | MICHELLE L TUCKER |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX 677993) |
Additional Taxonomies | 261QU0200X Clinic/Center, Urgent Care |
Enumeration Date | 2012-10-18 |
Last Update Date | 2024-10-14 |