NPI | 1114409596 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MA RN2319631) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: MA RN2319631) |
363LF0000X Nurse Practitioner, Family (Licence: MA RN2319631) | |
Enumeration Date | 2018-09-03 |
Last Update Date | 2022-09-08 |