| NPI | 1104402379 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MI 4704354204) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MI 4704354204) |
| Enumeration Date | 2021-03-19 |
| Last Update Date | 2023-10-10 |