| NPI | 1073914404 | 
|---|---|
| Entity Type | Individual | 
| Gender | Female | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: MD R225313) | 
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: IA H117701) | 
| 363LG0600X Nurse Practitioner, Gerontology (Licence: IA H117701) | |
| 363LP2300X Nurse Practitioner, Primary Care (Licence: IA H117701) | |
| 163W00000X Registered Nurse (Licence: MD R225313) | |
| Enumeration Date | 2014-09-04 | 
| Last Update Date | 2017-01-04 |