| NPI | 1104215763 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LW0102X Nurse Practitioner Women's Health (Licence: GA RN211840) |
| Additional Taxonomies | 163WW0101X Registered Nurse Women's Health Care, Ambulatory (Licence: GA RN211840) |
| Enumeration Date | 2015-01-20 |
| Last Update Date | 2015-01-20 |