| NPI | 1891031621 |
|---|---|
| Former Name | MARY ELLEN HEROD |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: ID 66049) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NM CNP-02460) |
| 363LF0000X Nurse Practitioner, Family (Licence: OR 201250210NP) | |
| Enumeration Date | 2012-12-26 |
| Last Update Date | 2021-07-16 |