| NPI | 1063778017 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CO 2567) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CO 85753) |
| 363LF0000X Nurse Practitioner, Family (Licence: WY 20039.0746) | |
| Enumeration Date | 2012-04-04 |
| Last Update Date | 2014-06-12 |