NPI | 1104462738 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IL 209.021965) |
Additional Taxonomies | 163WP2201X Registered Nurse, Ambulatory Care (Licence: IL 041434377) |
Enumeration Date | 2019-11-19 |
Last Update Date | 2020-09-16 |