| NPI | 1104301522 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MO 2017022220) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: KS 78353) |
| Enumeration Date | 2018-10-02 |
| Last Update Date | 2021-03-18 |