| NPI | 1023767811 | 
|---|---|
| Entity Type | Individual | 
| Gender | Female | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MO 2022009501)  | 
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: KS 53-80602-121)  | 
| Enumeration Date | 2022-03-21 | 
| Last Update Date | 2022-03-21 |