Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 53-75302-112 | KS |
NPI | 1003110446 |
---|---|
Provider Name | Miriam Colleen Slaugh |
First Address | Lawrence, KS 66044-1335 |
Second Address | Lawrence, KS 66044 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/12/2010 |
Last Update Date | 28/04/2014 |