| NPI | 1083136014 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 164W00000X Licensed Practical Nurse (Licence: OH 146438) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH cdca.167855) |
| Enumeration Date | 2017-07-12 |
| Last Update Date | 2018-08-08 |