NPI | 1104474725 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: LA 208487) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: LA RN085658) |
Enumeration Date | 2019-08-27 |
Last Update Date | 2019-09-19 |