| NPI | 1972763340 |
|---|---|
| Former Name | NICOLE DAWNETTE MATHIS |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: LA MD-202933) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: TX P2489) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2008-06-10 |
| Last Update Date | 2014-09-15 |