| NPI | 1104178896 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: WI 14116) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: PA SP012418) |
| 363LF0000X Nurse Practitioner, Family (Licence: FL 11005606) | |
| Enumeration Date | 2012-10-05 |
| Last Update Date | 2025-11-12 |