| NPI | 1063259489 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WI 15536) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: WI 15536) |
| Enumeration Date | 2024-07-12 |
| Last Update Date | 2026-03-27 |