| NPI | 1164169876 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: TX 1073152) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: TX 1073152) |
| Enumeration Date | 2022-05-14 |
| Last Update Date | 2022-11-11 |