| NPI | 1053801456 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: ID 40407) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: ID 40407) |
| Enumeration Date | 2018-05-11 |
| Last Update Date | 2019-03-12 |