| NPI | 1104394493 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2200X Nurse Practitioner Adult Health (Licence: IL 209018442) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: IL 209.018442) |
| Enumeration Date | 2018-11-05 |
| Last Update Date | 2025-04-03 |