| NPI | 1063787422 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MD MC4212469) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: VA 0024169953) |
| Enumeration Date | 2012-03-19 |
| Last Update Date | 2021-10-14 |