| NPI | 1811586951 |
|---|---|
| Former Name | KELLY SOPER |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MA RN2266901) |
| Additional Taxonomies | 2086S0127X Surgery Trauma Surgery (Licence: MA RN2266901) |
| Enumeration Date | 2021-01-13 |
| Last Update Date | 2021-03-30 |