| NPI | 1104480136 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: TX 1073868) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MA RN2311744) |
| Enumeration Date | 2019-04-25 |
| Last Update Date | 2022-10-14 |