NPI | 1063759496 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA 95019881) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: AK 189947) |
363LF0000X Nurse Practitioner, Family (Licence: TX 604251) | |
Enumeration Date | 2013-01-04 |
Last Update Date | 2022-05-26 |