NPI | 1841533601 |
---|---|
Former Name | LYDIA KOSTRUKOFF |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CA 276394) |
Additional Taxonomies | 163WM0705X Registered Nurse, Medical-Surgical (Licence: CA 276394) |
Enumeration Date | 2013-03-30 |
Last Update Date | 2013-03-30 |