| NPI | 1104712975 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MD AC007994) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NM 64056) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NM 64056) | |
| Enumeration Date | 2025-06-17 |
| Last Update Date | 2025-10-15 |