| NPI | 1083296867 | 
|---|---|
| Entity Type | Individual | 
| Gender | Female | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NC 5014372) | 
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NC F08200879) | 
| Enumeration Date | 2021-04-22 | 
| Last Update Date | 2023-04-17 |