| NPI | 1114569951 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CT 12.008555) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CT 10.164998) |
| Enumeration Date | 2019-10-14 |
| Last Update Date | 2019-10-18 |