| NPI | 1174104053 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NY 347579) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: NY 577113) |
| 363LF0000X Nurse Practitioner Family (Licence: NY 347579) | |
| Enumeration Date | 2021-04-21 |
| Last Update Date | 2023-04-17 |