| NPI | 1144693565 | 
|---|---|
| Entity Type | Individual | 
| Gender | Female | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MO 2015036182)  | 
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: KS 77043)  | 
| Enumeration Date | 2015-11-06 | 
| Last Update Date | 2015-12-01 |