| NPI | 1104107275 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MO 2015018011) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: KS 53-75464) |
| Enumeration Date | 2011-09-02 |
| Last Update Date | 2020-10-09 |