| NPI | 1104215219 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: WA AP611181434) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MA 2259942) |
| Enumeration Date | 2015-01-13 |
| Last Update Date | 2022-02-15 |