| NPI | 1063778652 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: NC 50067900) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: IN 28200669A) |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: IN 71003928A) | |
| Enumeration Date | 2012-04-09 |
| Last Update Date | 2014-12-18 |