| NPI | 1053374520 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics (Licence: TX AP107963) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: TX 555423) |
| 363LF0000X Nurse Practitioner, Family (Licence: TX 555423) | |
| Enumeration Date | 2006-04-07 |
| Last Update Date | 2021-01-05 |