| NPI | 1154953073 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: UT 5339496-4405) |
| Additional Taxonomies | 363LP2300X Nurse Practitioner, Primary Care (Licence: UT 5339496-8900) |
| 363LP2300X Nurse Practitioner, Primary Care (Licence: OR 201910986RN) | |
| Enumeration Date | 2020-02-08 |
| Last Update Date | 2022-01-06 |