| NPI | 1164523098 | 
|---|---|
| Entity Type | Individual | 
| Gender | Female | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: AZ RN044136/APO199)  | 
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: AZ RN044136/APO199)  | 
| Enumeration Date | 2006-09-25 | 
| Last Update Date | 2016-03-30 |