| NPI | 1063709640 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: KS 53-75545-082) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MO 2011031858) |
| Enumeration Date | 2011-07-05 |
| Last Update Date | 2025-10-03 |