| NPI | 1164406260 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics (Licence: MO 077428) |
| Additional Taxonomies | 363LP0200X Nurse Practitioner, Pediatrics (Licence: KS 44356) |
| Enumeration Date | 2005-12-01 |
| Last Update Date | 2011-01-31 |