| NPI | 1114778602 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NY 357673) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: NJ 26NJ15041400) |
| Enumeration Date | 2024-04-01 |
| Last Update Date | 2025-10-14 |