| NPI | 1104463793 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: KY 3014133) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: KY 1115588) |
| Enumeration Date | 2019-12-03 |
| Last Update Date | 2019-12-13 |