| NPI | 1104114727 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: TX 800411) |
| Additional Taxonomies | 363LG0600X Nurse Practitioner, Gerontology (Licence: TX 800411) |
| 363LF0000X Nurse Practitioner, Family (Licence: TX 800411) | |
| Enumeration Date | 2011-07-17 |
| Last Update Date | 2016-12-16 |