NPI | 1770223240 |
---|---|
Former Name | MARISA LYNN MITCHELL |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 036176590) |
Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
Enumeration Date | 2022-03-31 |
Last Update Date | 2025-08-20 |