| NPI | 1063957843 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: IA A154773) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: TN 22103) |
| 363LF0000X Nurse Practitioner, Family (Licence: TN 22103) | |
| Enumeration Date | 2017-01-03 |
| Last Update Date | 2019-07-12 |