| NPI | 1114691318 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA MA062696) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NC 0010-15085) |
| 363AM0700X Physician Assistant, Medical (Licence: PA MA062696) | |
| 364SP0807X Clinical Nurse Specialist, Psych/Mental Health, Child & Adolescent (Licence: PA MA062696) | |
| 364SP0809X Clinical Nurse Specialist, Psych/Mental Health, Adult (Licence: PA MA062696) | |
| Enumeration Date | 2021-08-03 |
| Last Update Date | 2025-02-24 |