| NPI | 1164679304 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: KY 3011611) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: WV 66400) |
| 363LF0000X Nurse Practitioner Family (Licence: IL 209.007921) | |
| Enumeration Date | 2008-08-19 |
| Last Update Date | 2022-07-21 |