| NPI | 1740557289 |
|---|---|
| Former Name | STEPHANIE R MACTAVISH |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: WA AP60474118) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: WA AP60474118) |
| Enumeration Date | 2011-11-29 |
| Last Update Date | 2021-08-13 |