| NPI | 1912255001 |
|---|---|
| Former Name | MIKELLA BLAKE OWEN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: TN 16877) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN 144170) |
| Enumeration Date | 2012-08-21 |
| Last Update Date | 2023-05-23 |