| NPI | 1003209404 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: KS 77058) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MO 2003016247) |
| 363LF0000X Nurse Practitioner, Family (Licence: MO 2015001944) | |
| Enumeration Date | 2015-03-09 |
| Last Update Date | 2016-03-28 |