| NPI | 1164976379 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: KY 3010619) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: KY 3010619) |
| 363LF0000X Nurse Practitioner, Family (Licence: KY 3010619) | |
| Enumeration Date | 2016-08-05 |
| Last Update Date | 2021-02-22 |