| NPI | 1114920402 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: UT 8721544-4405) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: WV 0389765-22) |
| 363LF0000X Nurse Practitioner, Family (Licence: VA 0024166259) | |
| Enumeration Date | 2005-05-31 |
| Last Update Date | 2021-06-01 |