| NPI | 1124582762 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: VA 0024188837) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: VA 0001251620) |
| Enumeration Date | 2019-01-28 |
| Last Update Date | 2023-12-02 |