| NPI | 1114122918 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: AZ AP4842) |
| Additional Taxonomies | 363LP0200X Nurse Practitioner, Pediatrics (Licence: IL 209005271) |
| 363L00000X Nurse Practitioner (Licence: WI 177089) | |
| Enumeration Date | 2007-06-20 |
| Last Update Date | 2017-10-30 |