| NPI | 1114325099 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: SC 20229) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: VA 0024132296) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: VA 0024132296) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: SC 20229) | |
| 363LF0000X Nurse Practitioner, Family (Licence: SC 20229) | |
| Enumeration Date | 2014-12-09 |
| Last Update Date | 2016-06-07 |