| NPI | 1104813864 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: IA 075154) |
| Additional Taxonomies | 363LP0200X Nurse Practitioner, Pediatrics (Licence: IA C075154) |
| Enumeration Date | 2005-09-28 |
| Last Update Date | 2007-11-21 |