| NPI | 1134679012 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: NC 5009104) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: NC 5009104) |
| 363LP2300X Nurse Practitioner, Primary Care (Licence: SC 20490) | |
| Enumeration Date | 2016-10-04 |
| Last Update Date | 2021-02-22 |