| NPI | 1154992022 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics (Licence: CA 95017750) |
| Additional Taxonomies | 171000000X Military Health Care Provider |
| 363L00000X Nurse Practitioner (Licence: CA 95017750) | |
| Enumeration Date | 2021-07-01 |
| Last Update Date | 2025-07-23 |