NPI | 1912544545 |
---|---|
Former Name | AMY ELIZABETH LATHEM |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: KY 4016492) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: OH cnp.024034) |
363LP0200X Nurse Practitioner, Pediatrics (Licence: OH APRN.CNP.024034) | |
Enumeration Date | 2019-12-02 |
Last Update Date | 2024-08-20 |