| NPI | 1063911691 | 
|---|---|
| Entity Type | Individual | 
| Gender | Female | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: OR 201605428LPN) | 
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: FL PN5187199) | 
| 101YM0800X Counselor, Mental Health | |
| Enumeration Date | 2018-02-09 | 
| Last Update Date | 2021-02-18 |