NPI | 1104305630 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: MI 4704271784) |
Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: MI 4704271784) |
Enumeration Date | 2018-08-06 |
Last Update Date | 2021-01-06 |