| NPI | 1104174531 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: GA RN188604) |
| Additional Taxonomies | 163WP2201X Registered Nurse, Ambulatory Care (Licence: TN 17691) |
| 363LF0000X Nurse Practitioner, Family (Licence: GA RN188604) | |
| Enumeration Date | 2012-08-15 |
| Last Update Date | 2022-04-12 |