| NPI | 1124410659 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: KS 76769) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MO 2015000385) |
| Enumeration Date | 2015-02-20 |
| Last Update Date | 2019-01-14 |