| NPI | 1104471309 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: VA 00241718191) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: VA 0001225659) |
| Enumeration Date | 2019-08-05 |
| Last Update Date | 2020-12-02 |