| NPI | 1114421591 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MO 2018027758) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MO 1999136900) |
| 363LF0000X Nurse Practitioner Family (Licence: MO 1999136900) | |
| Enumeration Date | 2018-03-21 |
| Last Update Date | 2020-04-02 |