| NPI | 1104399880 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MI 4704220646) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MI 4704220646) |
| 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11014812) | |
| Enumeration Date | 2019-01-06 |
| Last Update Date | 2024-01-03 |