NPI | 1902215130 |
---|---|
Former Name | DIANE KATHERINE GONSIOR |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: IL 209011636) |
Additional Taxonomies | 363LG0600X Nurse Practitioner, Gerontology (Licence: IL 209011636) |
363LP2300X Nurse Practitioner, Primary Care (Licence: IL 209011636) | |
Enumeration Date | 2014-08-13 |
Last Update Date | 2021-05-05 |