NPI | 1831165349 |
---|---|
Former Name | JOY MAE FAIR |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: VA 0024075667) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: VA 0001075667) |
Enumeration Date | 2006-02-24 |
Last Update Date | 2010-06-10 |