| NPI | 1104476563 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MA RN2328803) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MA RN2328803) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MA RN2328803) | |
| Enumeration Date | 2019-09-18 |
| Last Update Date | 2023-03-10 |