| NPI | 1124670484 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: PA SP020541) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: PA RN623946) |
| Enumeration Date | 2019-07-16 |
| Last Update Date | 2019-07-23 |