Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP2300X | Nurse Practitioner - Primary Care | 9226358 | FL |
NPI | 1053838235 |
---|---|
Provider Name | Mrs. Carmen Denise Wesley |
First Address | Miramar, FL 33027-6011 |
Second Address | Aventura, FL 33180-1232 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/08/2017 |
Last Update Date | 04/04/2018 |