NPI | 1770915290 |
---|---|
Former Name | REGINA L MILLER |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: IL 209003549) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: ME CNP131051) |
Enumeration Date | 2013-08-07 |
Last Update Date | 2014-11-06 |