| NPI | 1164898201 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: SD CP001234) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: ID NP-1612A) |
| Enumeration Date | 2015-08-12 |
| Last Update Date | 2025-07-07 |