| NPI | 1124772454 | 
|---|---|
| Entity Type | Individual | 
| Gender | Female | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL 11018117) | 
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL 9406648) | 
| Enumeration Date | 2022-02-06 | 
| Last Update Date | 2022-07-12 |