| NPI | 1063735504 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NC 5010316) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: WI 3999-33) |
| 363LG0600X Nurse Practitioner, Gerontology (Licence: WI 3999) | |
| Enumeration Date | 2010-03-11 |
| Last Update Date | 2018-04-05 |