| NPI | 1073865598 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: WI 5505) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: WI 5505) |
| 363LF0000X Nurse Practitioner, Family (Licence: IL 209009865) | |
| Enumeration Date | 2012-10-08 |
| Last Update Date | 2014-10-16 |