| NPI | 1881854990 |
|---|---|
| Former Name | NICOLE TERESA BLEAKLY |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0203X Pediatrics, Pediatric Critical Care Medicine (Licence: CA A109795) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CA A109795) |
| Enumeration Date | 2008-06-12 |
| Last Update Date | 2019-01-15 |