| NPI | 1194248179 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MS 904035) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: OR 201704278NP-PP) |
| 363LF0000X Nurse Practitioner, Family (Licence: MS 904035) | |
| Enumeration Date | 2017-07-20 |
| Last Update Date | 2020-10-26 |