| NPI | 1184969958 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner Primary Care (Licence: NE 111435) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MN 210815-9) |
| 163WG0000X Registered Nurse General Practice (Licence: NE 41796) | |
| Enumeration Date | 2012-12-05 |
| Last Update Date | 2015-05-15 |