| NPI | 1053920751 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics (Licence: MD R229373) |
| Additional Taxonomies | 363LP0200X Nurse Practitioner, Pediatrics (Licence: VA 0024180401) |
| 363LP2300X Nurse Practitioner, Primary Care (Licence: VA 0024180401) | |
| 363LP2300X Nurse Practitioner, Primary Care (Licence: MD R229373) | |
| Enumeration Date | 2020-07-28 |
| Last Update Date | 2021-08-13 |