| NPI | 1063403418 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: MO 2005035596) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: MO 2004008789) |
| 363LP2300X Nurse Practitioner, Primary Care (Licence: MO 2005035596) | |
| Enumeration Date | 2005-11-03 |
| Last Update Date | 2018-06-25 |