| NPI | 1164489928 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: TX 1003352) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 829958) |
| 171W00000X Contractor (Licence: TX AT2648) | |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: TX AT2648) | |
| Enumeration Date | 2006-04-27 |
| Last Update Date | 2022-06-08 |