| NPI | 1811234412 |
|---|---|
| Former Name | MARLENE GERISE DOUGLASS |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics (Licence: PA SP012515) |
| Additional Taxonomies | 363LP0200X Nurse Practitioner, Pediatrics (Licence: DE LJ-0000380) |
| Enumeration Date | 2013-01-16 |
| Last Update Date | 2023-11-01 |