| NPI | 1043363534 | 
|---|---|
| Entity Type | Individual | 
| Gender | Female | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NC 5004102)  | 
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: PA SP008019)  | 
| Enumeration Date | 2007-01-19 | 
| Last Update Date | 2015-07-21 |