| NPI | 1063808210 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: VT 101.0134268) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 406312) |
| Enumeration Date | 2015-04-14 |
| Last Update Date | 2019-03-13 |