| NPI | 1043601164 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP2300X Nurse Practitioner Primary Care (Licence: MI 4704261932) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: MI 4704261932) |
| Enumeration Date | 2015-02-11 |
| Last Update Date | 2015-03-25 |