| NPI | 1912437617 |
|---|---|
| Former Name | LAUREL SHELBY LACKEY |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: CA A172755) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: SC 51154) |
| Enumeration Date | 2017-06-14 |
| Last Update Date | 2021-06-01 |