| NPI | 1124394259 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics (Licence: MI 4704201257) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MI 4704201257) |
| Enumeration Date | 2012-03-22 |
| Last Update Date | 2019-02-08 |