Individual
MRS. NANCY LEA UNDERDAHL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
4545 RANGE RD, NICEVILLE, FL 32578-8713
(850) 833-4240
(850) 833-4243
Mailing address
221 HOSPITAL DR NE, FORT WALTON BEACH, FL 32548-5066
(850) 833-9240
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
PN1332311
FL
Other
Enumeration date
10/24/2007
Last updated
02/11/2008
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