| NPI | 1063501765 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MA RN10003464) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MI 4704170436) |
| Enumeration Date | 2006-10-12 |
| Last Update Date | 2025-11-21 |