| NPI | 1154371466 | 
|---|---|
| Entity Type | Individual | 
| Gender | Female | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: UT 324632-4405) | 
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: UT 324632-4405) | 
| 363LP0200X Nurse Practitioner, Pediatrics (Licence: UT 324632-4405) | |
| Enumeration Date | 2006-05-10 | 
| Last Update Date | 2021-11-08 |