| NPI | 1083170211 | 
|---|---|
| Entity Type | Individual | 
| Gender | Female | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NY F-343947-1)  | 
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 657042)  | 
| Enumeration Date | 2019-02-12 | 
| Last Update Date | 2019-02-12 |