| NPI | 1154742112 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MO 2013040389) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MO 2013040389) |
| Enumeration Date | 2013-12-18 |
| Last Update Date | 2020-10-22 |