| NPI | 1861636003 |
|---|---|
| Former Name | ANGELA RENEE ETHRIDGE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OR MD157915) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| Enumeration Date | 2009-04-30 |
| Last Update Date | 2018-04-11 |