| NPI | 1053954677 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN111019366) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: GA F08190712) |
| Enumeration Date | 2019-10-27 |
| Last Update Date | 2022-06-16 |