| NPI | 1174295158 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11024599) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: VA 0024182719) |
| Enumeration Date | 2021-09-29 |
| Last Update Date | 2023-02-21 |