| NPI | 1104028158 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: VA 1104022858) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: VA 0024165830) |
| Enumeration Date | 2007-06-01 |
| Last Update Date | 2012-03-15 |