| NPI | 1962175935 |
|---|---|
| Former Name | MADELINE KELLIE DOUGLAS |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics (Licence: TN 32847) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN 249815) |
| Enumeration Date | 2021-07-27 |
| Last Update Date | 2023-07-25 |