| NPI | 1013260421 | 
|---|---|
| Entity Type | Individual | 
| Gender | Female | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 208VP0000X (Licence: OH COA.14058-NP) | 
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: OH F0912131) | 
| Enumeration Date | 2012-10-23 | 
| Last Update Date | 2015-07-10 |