NPI | 1740376722 |
---|---|
Former Name | SUSAN ELIZABETH TYLER |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363LP0200X Nurse Practitioner Pediatrics (Licence: NY F381090) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 325709) |
Enumeration Date | 2006-10-05 |
Last Update Date | 2008-09-25 |