| NPI | 1104170786 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: KY 3007766) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: KY 3007766) |
| 363LF0000X Nurse Practitioner Family (Licence: KY 3007766) | |
| Enumeration Date | 2012-11-02 |
| Last Update Date | 2025-06-17 |