Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP2300X | Nurse Practitioner - Primary Care | RN040164 | GA |
NPI | 1003129032 |
---|---|
Provider Name | Catherine Espitallier |
First Address | Hephzibah, GA 30815-4311 |
Second Address | Hephzibah, GA 30815-4311 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2010 |
Last Update Date | 19/07/2010 |