| NPI | 1174983969 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL 9233994) |
| Additional Taxonomies | 324500000X Substance Abuse Rehabilitation Facility (Licence: FL 1003436) |
| Enumeration Date | 2016-03-07 |
| Last Update Date | 2018-11-07 |