| NPI | 1104119700 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 164W00000X Licensed Practical Nurse (Licence: SD P010469) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: OK 0057916) |
| Enumeration Date | 2011-05-16 |
| Last Update Date | 2011-05-16 |