| NPI | 1104207034 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MD AC004640) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: GA 254126) |
| 163W00000X Registered Nurse (Licence: NY 671463) | |
| 363LF0000X Nurse Practitioner, Family (Licence: NY 346732) | |
| Enumeration Date | 2015-06-16 |
| Last Update Date | 2022-09-06 |