| NPI | 1104365139 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MO 2017006105) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MO 2008020731) |
| 163W00000X Registered Nurse (Licence: KS 14-106437-062) | |
| 363LF0000X Nurse Practitioner, Family (Licence: KS 53-77592-062) | |
| Enumeration Date | 2017-02-23 |
| Last Update Date | 2017-03-13 |