| NPI | 1730762915 |
|---|---|
| Former Name | LACEY SHREVE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: LA 343381) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MS SHRE-AN9HP9) |
| Enumeration Date | 2021-05-04 |
| Last Update Date | 2024-09-24 |