| NPI | 1871629055 |
|---|---|
| Former Name | MARY KATHRYN DERIEG |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: CA 704767) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: OR 200750019NP) |
| Enumeration Date | 2007-02-24 |
| Last Update Date | 2025-11-07 |