| NPI | 1104265149 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CT 5421) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CT 104299) |
| Enumeration Date | 2013-06-24 |
| Last Update Date | 2013-08-06 |