| NPI | 1104149905 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: LA AP06049) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: LA RN 098182) |
| Enumeration Date | 2010-03-08 |
| Last Update Date | 2011-03-04 |