| NPI | 1780789438 |
|---|---|
| Former Name | ROBERTA R MCCONVILLE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: KS ARNP 74314) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: KS RN-13-38358-101) |
| Enumeration Date | 2006-09-14 |
| Last Update Date | 2012-03-02 |