| NPI | 1003371931 | 
|---|---|
| Entity Type | Individual | 
| Gender | Female | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: SC 22594) | 
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: SC 22594) | 
| Enumeration Date | 2019-02-05 | 
| Last Update Date | 2019-06-07 |