| NPI | 1083819296 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: CO 2895) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: CO 27368) |
| Enumeration Date | 2007-06-18 |
| Last Update Date | 2010-12-03 |