| NPI | 1073055463 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics (Licence: MO 2017040765) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: KS 77500) |
| 363LP0200X Nurse Practitioner, Pediatrics (Licence: KS 77500) | |
| Enumeration Date | 2016-11-16 |
| Last Update Date | 2026-06-24 |