| NPI | 1053336990 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OR 201350015NP) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: AK 884) |
| Enumeration Date | 2006-07-13 |
| Last Update Date | 2015-09-03 |