| NPI | 1053761924 | 
|---|---|
| Entity Type | Individual | 
| Gender | Female | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: VA 0024186726) | 
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: UT 8635924-4405) | 
| Enumeration Date | 2016-06-21 | 
| Last Update Date | 2024-09-20 |