| NPI | 1962790436 |
|---|---|
| Former Name | SUSAN MARIE WAKEFIELD |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: MO 2011014368) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: KS 5375388101) |
| Enumeration Date | 2011-07-18 |
| Last Update Date | 2011-07-18 |