| NPI | 1053636464 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: PA SP010225) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: PA RN555859) |
| Enumeration Date | 2010-03-30 |
| Last Update Date | 2010-03-30 |