| NPI | 1164217832 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: WV 124165) |
| Additional Taxonomies | 163WA2000X Registered Nurse, Administrator (Licence: OH 396243) |
| Enumeration Date | 2025-04-11 |
| Last Update Date | 2025-09-09 |