| NPI | 1083281174 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: MS 904670) |
| Additional Taxonomies | 261QP2300X Clinic/Center, Primary Care |
| 261QP2300X Clinic/Center, Primary Care | |
| Enumeration Date | 2021-06-07 |
| Last Update Date | 2021-09-16 |