| NPI | 1891222808 |
|---|---|
| Former Name | TESS LACIE EDVARDSEN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IN PENDING) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| Enumeration Date | 2017-05-22 |
| Last Update Date | 2021-01-12 |