Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | R0085887 | OK |
NPI | 1053710798 |
---|---|
Provider Name | Debra Sizemore |
First Address | Yigo, GU 96929 |
Second Address | Yigo, GU 96929 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/08/2014 |
Last Update Date | 08/02/2022 |