| NPI | 1104863810 | 
|---|---|
| Entity Type | Individual | 
| Gender | Female | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MO 129258)  | 
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: MO 129258)  | 
| 364S00000X Clinical Nurse Specialist (Licence: KS 5374713)  | |
| 364SM0705X Clinical Nurse Specialist, Medical-Surgical (Licence: KS 5374713)  | |
| 364SM0705X Clinical Nurse Specialist, Medical-Surgical (Licence: MO 129258)  | |
| Enumeration Date | 2006-06-01 | 
| Last Update Date | 2022-04-08 |