NPI | 1790204758 |
---|---|
Former Name | DEVON SHEA GRIFFIN |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CA 95007011) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: CA 95007011) |
Enumeration Date | 2017-09-11 |
Last Update Date | 2018-01-03 |