| NPI | 1083035083 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MO 2013041169) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: KS 76206) |
| Enumeration Date | 2013-12-18 |
| Last Update Date | 2014-01-18 |