| NPI | 1124785662 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: AZ 9714) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: AZ 9714) |
| 363A00000X Physician Assistant (Licence: UT 12546422-1206) | |
| Enumeration Date | 2021-11-18 |
| Last Update Date | 2025-04-03 |