| NPI | 1104290600 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MO 2015043741) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MO 2013017571) |
| Enumeration Date | 2015-11-20 |
| Last Update Date | 2017-11-16 |