NPI | 1053955310 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IL 209.023481) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: IL 041424291) |
Enumeration Date | 2019-10-30 |
Last Update Date | 2021-07-15 |