| NPI | 1104378678 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: GA RN259680) |
| Additional Taxonomies | 163WG0600X Registered Nurse, Gerontology (Licence: GA RN259680) |
| 163WG0600X Registered Nurse, Gerontology (Licence: MS R624608) | |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: MS 901572) | |
| Enumeration Date | 2016-10-31 |
| Last Update Date | 2018-02-01 |