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 |