| NPI | 1104859875 | 
|---|---|
| Entity Type | Individual | 
| Gender | Female | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: AZ AP4970) | 
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: WA AP30005619) | 
| Enumeration Date | 2006-07-08 | 
| Last Update Date | 2024-11-07 |