| NPI | 1164706693 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NE 111282) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NE 111282) |
| 363L00000X Nurse Practitioner (Licence: IA A131660) | |
| Enumeration Date | 2011-10-03 |
| Last Update Date | 2016-09-01 |