| NPI | 1740660117 |
|---|---|
| Former Name | BETH ELLEN BOURNE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: WI 71316) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: MN 61229) |
| Enumeration Date | 2015-06-01 |
| Last Update Date | 2022-08-10 |