| NPI | 1013360395 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 282N00000X General Acute Care Hospital (Licence: FL 4450) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME 94731) |
| 302F00000X Exclusive Provider Organization | |
| 363L00000X Nurse Practitioner (Licence: FL AG0316099) | |
| Enumeration Date | 2016-07-21 |
| Last Update Date | 2016-07-21 |