| NPI | 1861966970 |
|---|---|
| Former Name | WAUNETA GRACE TATUM |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IN 71009086A) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: IN 28147974A) |
| Enumeration Date | 2019-01-11 |
| Last Update Date | 2022-01-20 |