| NPI | 1902516560 |
|---|---|
| Former Name | DANETTE GOLLADAY |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics (Licence: MI 4704283082NSA2309M) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| Enumeration Date | 2022-12-05 |
| Last Update Date | 2023-05-28 |