| NPI | 1891288031 |
|---|---|
| Former Name | TARA LEIGH ILSLEY |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: NY 431384) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 581597) |
| Enumeration Date | 2018-06-12 |
| Last Update Date | 2018-08-15 |