| NPI | 1891365607 |
|---|---|
| Former Name | TYVA MICHELLE SPROUSE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: MO 2021023514) |
| Enumeration Date | 2021-06-25 |
| Last Update Date | 2021-06-25 |