| NPI | 1174160485 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: MO 2019036525) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MO 2019036525) |
| 363L00000X Nurse Practitioner (Licence: KS 53-79077-062) | |
| Enumeration Date | 2019-12-05 |
| Last Update Date | 2021-12-06 |