NPI | 1790075422 |
---|---|
Former Name | CHRYSTAL GROOMS |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics (Licence: TX 739918) |
Additional Taxonomies | 163WP0200X Registered Nurse, Pediatrics (Licence: TX 739918) |
363LP0200X Nurse Practitioner, Pediatrics (Licence: FL APRN11028321) | |
Enumeration Date | 2011-04-14 |
Last Update Date | 2024-11-21 |