| NPI | 1174963136 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0200X Nurse Practitioner Pediatrics (Licence: ME CNP191176) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: PA RN632009) |
| 163W00000X Registered Nurse (Licence: MA RN2281692) | |
| 363LP0200X Nurse Practitioner Pediatrics (Licence: MA RN2281692) | |
| Enumeration Date | 2013-07-04 |
| Last Update Date | 2019-08-13 |