| 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 |