| NPI | 1164040259 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: FL APRN110078) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL 11007889) |
| Enumeration Date | 2020-07-06 |
| Last Update Date | 2021-01-29 |