| NPI | 1053715599 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics (Licence: NC 189070) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NC 189070) |
| 363LP0200X Nurse Practitioner, Pediatrics (Licence: NC 5007193) | |
| Enumeration Date | 2014-10-13 |
| Last Update Date | 2022-02-15 |