| NPI | 1104864222 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: MI 4704220636) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MI 4704220636) |
| Enumeration Date | 2006-06-02 |
| Last Update Date | 2018-08-03 |