| NPI | 1114567922 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: FL 11005519) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: CT 008988) |
| Enumeration Date | 2020-01-09 |
| Last Update Date | 2020-08-03 |