| NPI | 1104823905 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: KY 3008426) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: IN 71001762A) |
| Enumeration Date | 2005-07-07 |
| Last Update Date | 2014-06-18 |