| NPI | 1104491935 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11006426) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: CT 11330) |
| Enumeration Date | 2021-05-24 |
| Last Update Date | 2023-06-14 |