| NPI | 1962603316 |
|---|---|
| Former Name | BETH L DIVIETRO |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: NY 304642) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 543658-1) |
| Enumeration Date | 2007-05-31 |
| Last Update Date | 2008-03-10 |