NPI | 1104344282 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: AL 1177516) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: WV APRN73533-FNP-BC) |
Enumeration Date | 2017-09-08 |
Last Update Date | 2021-05-18 |