NPI | 1134745581 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: GA RN323107) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MI 4704304130) |
363LF0000X Nurse Practitioner, Family (Licence: CT 11265) | |
363LF0000X Nurse Practitioner, Family (Licence: OH APRN.CNP.0027846) | |
Enumeration Date | 2020-06-22 |
Last Update Date | 2023-10-18 |