| NPI | 1063524791 | 
|---|---|
| Entity Type | Individual | 
| Gender | Female | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: AZ AP7639) | 
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: TX 666472) | 
| Enumeration Date | 2006-08-31 | 
| Last Update Date | 2021-03-17 |