| NPI | 1164768479 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: VA 0024172649) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: WV 60326) |
| Enumeration Date | 2012-12-14 |
| Last Update Date | 2019-10-04 |