NPI | 1982126595 |
---|---|
Former Name | CARISSA REANNA LOPEZ |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CO 0993330-NP) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: CO 0200426) |
363LF0000X Nurse Practitioner, Family (Licence: CO APN.0993330-NP) | |
Enumeration Date | 2017-07-14 |
Last Update Date | 2023-06-16 |