| NPI | 1104286756 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: NY F307606-1) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MA RN2304659) |
| 363L00000X Nurse Practitioner (Licence: NY F307606-1) | |
| Enumeration Date | 2016-02-24 |
| Last Update Date | 2017-02-03 |