| NPI | 1134779747 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MI 4704406162) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX AP142533) |
| 363LF0000X Nurse Practitioner, Family (Licence: ID 2261377) | |
| Enumeration Date | 2019-09-16 |
| Last Update Date | 2024-09-05 |