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 |