| NPI | 1174897466 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: KS 75962) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MO 2012006267) |
| Enumeration Date | 2012-03-04 |
| Last Update Date | 2022-01-31 |