| NPI | 1053880690 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: WI 9254-33) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: IL 209-018420) |
| 363LF0000X Nurse Practitioner, Family (Licence: IL 209.018420) | |
| 363LF0000X Nurse Practitioner, Family (Licence: WI 9254-33) | |
| 363LF0000X Nurse Practitioner, Family (Licence: IL 209-018420) | |
| Enumeration Date | 2018-11-13 |
| Last Update Date | 2019-05-28 |