| NPI | 1104821982 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: KY 3003587) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: IN 71014669A) |
| Enumeration Date | 2005-06-17 |
| Last Update Date | 2024-06-19 |