| NPI | 1104233410 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: FL 9446774) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: FL ARNP9446774) |
| 363LF0000X Nurse Practitioner, Family (Licence: MD R210168) | |
| Enumeration Date | 2014-07-18 |
| Last Update Date | 2022-01-25 |