| NPI | 1164995171 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: GA RN176796) |
| Additional Taxonomies | 363LG0600X Nurse Practitioner, Gerontology (Licence: GA RN176796) |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: GA RN176796) | |
| Enumeration Date | 2019-01-03 |
| Last Update Date | 2019-01-03 |