| NPI | 1003865411 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: KS 44978) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: KS 14-57009-061) |
| Enumeration Date | 2006-05-10 |
| Last Update Date | 2007-07-08 |