| NPI | 1063818425 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MA RN2292040) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: NH 0454) |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: MA 2540) | |
| 163W00000X Registered Nurse (Licence: MA RN2292040) | |
| 163W00000X Registered Nurse (Licence: ME RN65523) | |
| Enumeration Date | 2014-11-13 |
| Last Update Date | 2022-04-04 |