| NPI | 1871948166 |
|---|---|
| Former Name | STEFANIE KING |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: LA 325471) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: TN 2994) |
| 363AM0700X Physician Assistant, Medical (Licence: TN 2994) | |
| Enumeration Date | 2016-04-25 |
| Last Update Date | 2022-12-16 |