NPI | 1841952710 |
---|---|
Former Name | CHARICE AMBER PHELPS |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: SD CP002170) |
Additional Taxonomies | 261QU0200X Clinic/Center, Urgent Care |
363L00000X Nurse Practitioner (Licence: SD CP002170) | |
Enumeration Date | 2021-10-08 |
Last Update Date | 2022-04-26 |