| NPI | 1053986174 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: TX 1045202) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: GA RN205166) |
| Enumeration Date | 2021-05-21 |
| Last Update Date | 2022-07-19 |