| NPI | 1073286746 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MO 2021017874) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: KS 53-80494) |
| 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) | |
| Enumeration Date | 2021-07-28 |
| Last Update Date | 2026-04-06 |