| NPI | 1164569737 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: IA A132762) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: KS 45671) |
| Enumeration Date | 2007-01-31 |
| Last Update Date | 2020-03-11 |