| NPI | 1972225944 |
|---|---|
| Former Name | SANDRA DEBAULT |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IL 209-026355) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: IL 041434650) |
| Enumeration Date | 2022-09-15 |
| Last Update Date | 2024-01-09 |