| NPI | 1104242536 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0200X Nurse Practitioner Pediatrics (Licence: CT 5521) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: CT 5521) |
| Enumeration Date | 2014-03-10 |
| Last Update Date | 2015-03-24 |