NPI | 1962977140 |
---|---|
Former Name | KRYSTLE SHARNA BONCATO BEKALO |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: CA 95009956) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: CA 95009956) |
Enumeration Date | 2018-10-03 |
Last Update Date | 2018-10-10 |