| NPI | 1083655112 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: OH NP-05326) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MI 4704081852) |
| Enumeration Date | 2006-06-09 |
| Last Update Date | 2011-11-09 |