| NPI | 1073153912 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: WV 105024) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WV 88141) |
| 363L00000X Nurse Practitioner (Licence: KY 3018294) | |
| 363LF0000X Nurse Practitioner Family (Licence: KY 3018294) | |
| Enumeration Date | 2020-01-08 |
| Last Update Date | 2025-06-21 |