| NPI | 1063758100 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: OR 201603125NP-PP) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: OH NP-13808) |
| 363LF0000X Nurse Practitioner, Family (Licence: TX AP125593) | |
| Enumeration Date | 2012-12-18 |
| Last Update Date | 2018-10-23 |