NPI | 1841756145 |
---|---|
Former Name | MARIAH ANGELA GLASSCOCK |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TN 25627) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: TN 204986) |
Enumeration Date | 2019-02-12 |
Last Update Date | 2024-10-14 |