| NPI | 1124706643 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MD R164278) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MD R164278) |
| 363LF0000X Nurse Practitioner, Family (Licence: MD R164278) | |
| Enumeration Date | 2023-07-05 |
| Last Update Date | 2026-04-22 |