| NPI | 1750772562 |
|---|---|
| Former Name | TINA DANIELLE LAWALL |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner Adult Health (Licence: PA SP014368) |
| Additional Taxonomies | 363LG0600X Nurse Practitioner Gerontology (Licence: PA SP014368) |
| Enumeration Date | 2015-02-16 |
| Last Update Date | 2020-12-09 |