| NPI | 1932523917 |
|---|---|
| Former Name | TINA MARIE WANAMAKER |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX AP125662) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: AZ CRNA1046) |
| Enumeration Date | 2014-02-11 |
| Last Update Date | 2024-03-19 |