NPI | 1104442250 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: VA 0024179198) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: WV 105609) |
Enumeration Date | 2020-06-24 |
Last Update Date | 2023-01-26 |