| NPI | 1164400503 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: WI 590) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: WI 104375) |
| 363LF0000X Nurse Practitioner, Family (Licence: WI 590) | |
| Enumeration Date | 2006-01-05 |
| Last Update Date | 2022-01-17 |