| NPI | 1104517804 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LX0001X Nurse Practitioner, Obstetrics & Gynecology (Licence: UT CNM10181) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: UT 10666132-3102) |
| Enumeration Date | 2023-05-15 |
| Last Update Date | 2025-06-23 |