NPI | 1891928354 |
---|---|
Former Name | TARA WATKINS CLEMENTS |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NC 5005826) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NJ 26NJ00245700) |
Enumeration Date | 2009-09-01 |
Last Update Date | 2012-10-12 |