| NPI | 1104474394 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: PA SP019931) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: DE LP-0010644) |
| Enumeration Date | 2019-08-30 |
| Last Update Date | 2023-12-06 |