NPI | 1770605909 |
---|---|
Former Name | SHELLY S VANDER VELDEN |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NV 833930) |
Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: WA AP60644432) |
363L00000X Nurse Practitioner (Licence: AZ AP3667) | |
Enumeration Date | 2007-04-06 |
Last Update Date | 2021-12-16 |