| NPI | 1174816797 | 
|---|---|
| Entity Type | Individual | 
| Gender | Female | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MO 2011012310) | 
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: IL 209008834) | 
| Enumeration Date | 2011-05-16 | 
| Last Update Date | 2020-12-09 |