| NPI | 1104354711 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: VA 0024174759) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: VA 0024174759) |
| 163W00000X Registered Nurse (Licence: NC 261718) | |
| Enumeration Date | 2017-05-25 |
| Last Update Date | 2025-10-08 |