| NPI | 1164842712 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics (Licence: MO 2008021321) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MO 2008021321) |
| 363L00000X Nurse Practitioner (Licence: KY 3008568) | |
| Enumeration Date | 2014-04-22 |
| Last Update Date | 2022-11-08 |