| NPI | 1104223544 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MI 4704213030) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MI 4704213030) |
| 163W00000X Registered Nurse (Licence: MI L2394237) | |
| Enumeration Date | 2014-12-01 |
| Last Update Date | 2020-02-21 |