| NPI | 1861873556 |
|---|---|
| Former Name | MARY ST. GEORGE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: KS TMP 151317) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: KS 13-98436) |
| 163W00000X Registered Nurse (Licence: MO 2007016746) | |
| Enumeration Date | 2015-06-18 |
| Last Update Date | 2015-06-18 |