| NPI | 1114549565 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL APRN11036816) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: FL PN5232416) |
| Enumeration Date | 2020-05-08 |
| Last Update Date | 2025-03-13 |