| NPI | 1174205223 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11028131) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MA 2023063059) |
| Enumeration Date | 2023-08-07 |
| Last Update Date | 2023-12-21 |