| NPI | 1114318987 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MS 902936) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN 163971) |
| 363LF0000X Nurse Practitioner Family (Licence: TN 19660) | |
| Enumeration Date | 2015-02-13 |
| Last Update Date | 2018-12-17 |