| NPI | 1902368723 |
|---|---|
| Former Name | MICHELLE DAVIS |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: AL 1-156540) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: AL 1-156540) |
| Enumeration Date | 2019-04-01 |
| Last Update Date | 2021-01-01 |