| NPI | 1114087061 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner Primary Care (Licence: MI 4704154501) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MI 4704154501) |
| 363LC1500X Nurse Practitioner Community Health (Licence: MI 4704154501) | |
| Enumeration Date | 2006-12-11 |
| Last Update Date | 2019-05-24 |