| NPI | 1053207654 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: GA RN291962) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MI 4704426989) |
| Enumeration Date | 2025-06-18 |
| Last Update Date | 2026-03-03 |