| NPI | 1063424257 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: WI 5638-33) |
| Additional Taxonomies | 163WW0101X Registered Nurse Women's Health Care, Ambulatory (Licence: MI 4704147228) |
| 363LA2200X Nurse Practitioner Adult Health (Licence: WI 5638-33) | |
| 363LW0102X Nurse Practitioner Women's Health (Licence: WI 5638-33) | |
| Enumeration Date | 2006-08-13 |
| Last Update Date | 2014-06-19 |