| NPI | 1053865725 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MI 4704328365) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TX AP131107) |
| Enumeration Date | 2016-08-10 |
| Last Update Date | 2018-12-19 |