| NPI | 1104478015 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: FL 11004118) |
| Additional Taxonomies | 163WM0705X Registered Nurse, Medical-Surgical (Licence: FL RN9314916) |
| Enumeration Date | 2019-07-10 |
| Last Update Date | 2019-10-02 |