NPI | 1871291930 |
---|---|
Former Name | SAMANTHA JO MARTIN |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: IN 71014072A) |
Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: IN 71014072A) |
363LA2200X Nurse Practitioner, Adult Health (Licence: IN 71014072A) | |
Enumeration Date | 2023-02-20 |
Last Update Date | 2024-12-18 |