| NPI | 1154672186 | 
|---|---|
| Entity Type | Individual | 
| Gender | Female | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN1857372) | 
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: FL rn1857372) | 
| Enumeration Date | 2012-10-01 | 
| Last Update Date | 2019-01-09 |