| NPI | 1104817733 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: IN 71001771A) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MI 4704141786) |
| 363LF0000X Nurse Practitioner, Family (Licence: IN 71001771A) | |
| Enumeration Date | 2005-11-02 |
| Last Update Date | 2021-02-08 |