| NPI | 1093205049 | 
|---|---|
| Entity Type | Individual | 
| Gender | Female | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11002153)  | 
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: SC 21726)  | 
| 363L00000X Nurse Practitioner (Licence: NC 5010768)  | |
| Enumeration Date | 2018-05-15 | 
| Last Update Date | 2024-06-25 |