| NPI | 1104839554 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: SC 1393) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: SC 68296) |
| Enumeration Date | 2006-08-15 |
| Last Update Date | 2020-04-16 |