| NPI | 1952397952 |
|---|---|
| Former Name | DAWN LESLIE CARLOCK |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CO 4650) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CO 81123) |
| Enumeration Date | 2005-09-25 |
| Last Update Date | 2020-08-05 |