| NPI | 1972105021 |
|---|---|
| Former Name | THERESA FORMBY |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 175T00000X Peer Specialist |
| Enumeration Date | 2020-11-13 |
| Last Update Date | 2025-02-28 |