| NPI | 1104367614 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 164W00000X Licensed Practical Nurse (Licence: NC 05923) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: NY 225297) |
| Enumeration Date | 2017-03-16 |
| Last Update Date | 2017-03-16 |