Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | 0000000 | FL |
NPI | 1144879826 |
---|---|
Provider Name | Raicheton Chevette Le |
First Address | Indianapolis, IN 46268-2025 |
Second Address | Hollywood, FL 33021-5402 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/09/2019 |
Last Update Date | 05/09/2019 |