| NPI | 1063897130 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MA RN2292623) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MA RN2292623) |
| 163W00000X Registered Nurse (Licence: CT 119763) | |
| Enumeration Date | 2015-07-30 |
| Last Update Date | 2022-09-23 |