| NPI | 1043624810 | 
|---|---|
| Entity Type | Individual | 
| Gender | Female | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MI 4704272553) | 
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MI 4704272553) | 
| Enumeration Date | 2014-06-19 | 
| Last Update Date | 2016-05-13 |