| NPI | 1104947456 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: KS 75044) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MO 129464) |
| Enumeration Date | 2007-04-03 |
| Last Update Date | 2016-01-08 |