| NPI | 1104101856 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: DE LJ-0000339) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MD N32087) |
| 363LP0200X Nurse Practitioner, Pediatrics (Licence: DE LJ-0000339) | |
| Enumeration Date | 2011-10-13 |
| Last Update Date | 2019-03-22 |