| NPI | 1053781799 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MI 4704290000) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MI 4704290000) |
| 363LF0000X Nurse Practitioner, Family (Licence: MI F0715828) | |
| Enumeration Date | 2015-10-06 |
| Last Update Date | 2022-07-21 |