| NPI | 1184969495 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NE 111341) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NE 60597) |
| 363LF0000X Nurse Practitioner Family (Licence: NE 2011017917) | |
| Enumeration Date | 2012-11-28 |
| Last Update Date | 2014-01-23 |