| NPI | 1104334945 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: IL 277000185) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: IL 209.017015) |
| 363LF0000X Nurse Practitioner Family (Licence: IL 209.017015) | |
| Enumeration Date | 2018-01-15 |
| Last Update Date | 2022-01-03 |