| NPI | 1053635961 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: GA RN175692) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: AL 1-099962) |
| Enumeration Date | 2010-03-22 |
| Last Update Date | 2014-05-16 |