| NPI | 1174628994 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: KS 44544) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MO 115979) |
| 363LF0000X Nurse Practitioner Family (Licence: MO 115979) | |
| Enumeration Date | 2006-09-14 |
| Last Update Date | 2015-06-05 |