| NPI | 1053548107 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: SD CP000557) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: SD R038206) |
| 363LF0000X Nurse Practitioner, Family (Licence: ND R28565) | |
| Enumeration Date | 2009-06-16 |
| Last Update Date | 2022-03-31 |