| NPI | 1104695071 | 
|---|---|
| Entity Type | Individual | 
| Gender | Female | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11030220) | 
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL RN9304243) | 
| Enumeration Date | 2023-12-20 | 
| Last Update Date | 2025-10-02 |