| NPI | 1114314176 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NC 271972) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MN 1748) |
| Enumeration Date | 2015-04-16 |
| Last Update Date | 2016-10-04 |