| NPI | 1154028025 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: ND R56015) |
| Additional Taxonomies | 261QU0200X Clinic/Center, Urgent Care (Licence: VA 0101055731) |
| 261QU0200X Clinic/Center, Urgent Care (Licence: VA 0024186329) | |
| Enumeration Date | 2023-02-13 |
| Last Update Date | 2024-09-16 |