| NPI | 1093189219 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 164W00000X Licensed Practical Nurse (Licence: MI 4703109087) |
| Additional Taxonomies | 311ZA0620X Custodial Care Facility, Adult Care Home (Licence: MI 4703109087) |
| Enumeration Date | 2015-11-26 |
| Last Update Date | 2023-04-20 |