| NPI | 1174164263 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: OR 10055077) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: ID 77988) |
| Enumeration Date | 2019-10-01 |
| Last Update Date | 2026-03-03 |