| NPI | 1063827202 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WI 9727-33) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MT NUR-RN-LIC-25607) |
| Enumeration Date | 2014-06-26 |
| Last Update Date | 2020-01-23 |