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 |