| NPI | 1083348809 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: MA RN2363308) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist Athletic Trainer (Licence: MA 3104) |
| 163W00000X Registered Nurse (Licence: MA RN2363308) | |
| Enumeration Date | 2022-07-16 |
| Last Update Date | 2023-09-04 |