| NPI | 1174935803 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0200X Nurse Practitioner Pediatrics (Licence: GA RN261933) |
| Additional Taxonomies | 163WP0200X Registered Nurse Pediatrics (Licence: NY 630137) |
| 163WP0200X Registered Nurse Pediatrics (Licence: GA RN261933) | |
| 363LP0200X Nurse Practitioner Pediatrics (Licence: NY 382456) | |
| 363L00000X Nurse Practitioner (Licence: GA RN261933) | |
| 363L00000X Nurse Practitioner (Licence: NY 382456) | |
| Enumeration Date | 2014-05-29 |
| Last Update Date | 2021-02-05 |