| NPI | 1073041760 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: MO 2017010492) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: MO 2017010492) |
| 363LG0600X Nurse Practitioner, Gerontology (Licence: MO 2017010492) | |
| Enumeration Date | 2017-05-25 |
| Last Update Date | 2018-03-17 |