| NPI | 1073656120 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: AZ 392) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: WY 392) |
| 363LF0000X Nurse Practitioner Family (Licence: WY 27354.1007) | |
| Enumeration Date | 2007-02-15 |
| Last Update Date | 2018-03-17 |