| NPI | 1104312867 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: SC 21965) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: SC 227482) |
| 363L00000X Nurse Practitioner (Licence: SC 21965) | |
| Enumeration Date | 2018-07-06 |
| Last Update Date | 2021-11-10 |