| NPI | 1073123501 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: MI 4704313968) |
| Additional Taxonomies | 363LG0600X Nurse Practitioner Gerontology (Licence: MI 4704313968) |
| 363LP2300X Nurse Practitioner Primary Care (Licence: MI 4704313968) | |
| Enumeration Date | 2020-08-10 |
| Last Update Date | 2020-09-27 |