| NPI | 1063791622 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CT 004739) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: CT 4739) |
| 363L00000X Nurse Practitioner (Licence: CT 004739) | |
| Enumeration Date | 2011-08-12 |
| Last Update Date | 2016-10-11 |