| NPI | 1053896654 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MO 2018015056) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: IL 209017891) |
| 363LF0000X Nurse Practitioner, Family (Licence: MO 2018015056) | |
| Enumeration Date | 2018-09-28 |
| Last Update Date | 2018-11-29 |