| NPI | 1104457555 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IL 209.020871) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: IL 041.361314) |
| Enumeration Date | 2020-02-03 |
| Last Update Date | 2020-02-20 |