| NPI | 1134518574 | 
|---|---|
| Entity Type | Individual | 
| Gender | Female | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: MA 2293298) | 
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: MA RN2293298) | 
| Enumeration Date | 2015-01-22 | 
| Last Update Date | 2017-12-08 |