| NPI | 1053920496 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MI 4704402745) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: WI 198718) |
| Enumeration Date | 2020-07-30 |
| Last Update Date | 2023-09-13 |