| NPI | 1114512795 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: KY 3015882) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: TN 29268) |
| Enumeration Date | 2021-03-04 |
| Last Update Date | 2022-01-04 |