| NPI | 1104253954 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: UT 275995-4405) |
| Additional Taxonomies | 363LG0600X Nurse Practitioner, Gerontology (Licence: UT 275995-4405) |
| 363L00000X Nurse Practitioner (Licence: UT 275995-4405) | |
| 363LP2300X Nurse Practitioner, Primary Care (Licence: UT 275995-4405) | |
| Enumeration Date | 2013-10-10 |
| Last Update Date | 2021-10-21 |