| NPI | 1790982080 |
|---|---|
| Other Name | THERESA ANN BLACK |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: WV 49062) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: WV 49062) |
| Enumeration Date | 2007-06-29 |
| Last Update Date | 2023-11-29 |