NPI | 1104316454 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363LP0200X Nurse Practitioner Pediatrics (Licence: NY 382872) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: CT 137013) |
163W00000X Registered Nurse (Licence: NY 727527) | |
Enumeration Date | 2018-05-12 |
Last Update Date | 2022-01-18 |