NPI | 1881357168 |
---|---|
Former Name | KATELYN MARIE MATHISON |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IN 71013474A) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: IN 28229244A) |
Enumeration Date | 2021-10-14 |
Last Update Date | 2024-04-10 |