| NPI | 1174248165 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MA RN161828) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: MA AG07220221) |
| Enumeration Date | 2022-10-11 |
| Last Update Date | 2023-05-24 |