| NPI | 1164030896 | 
|---|---|
| Entity Type | Individual | 
| Gender | Female | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NC F02200469) | 
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NC 286398) | 
| Enumeration Date | 2020-07-20 | 
| Last Update Date | 2020-07-20 |