NPI | 1083178040 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: APRN11001322) |
Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: FL APRN11001322) |
Enumeration Date | 2019-01-24 |
Last Update Date | 2024-09-05 |