| NPI | 1164457743 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OR 201250013NP) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: UT 347249-4405) |
| Enumeration Date | 2006-07-11 |
| Last Update Date | 2012-05-29 |