| NPI | 1083975478 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MI 4704206746) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MI 4704206746) |
| Enumeration Date | 2012-06-02 |
| Last Update Date | 2019-02-05 |