| NPI | 1063004695 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MI 4704336745) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MI 4704336745) |
| Enumeration Date | 2021-02-04 |
| Last Update Date | 2021-09-30 |