| NPI | 1124690896 | 
|---|---|
| Entity Type | Individual | 
| Gender | Female | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NC 5022247) | 
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: AZ 259173) | 
| Enumeration Date | 2021-07-13 | 
| Last Update Date | 2025-10-07 |