| NPI | 1194367078 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: PA SP024200) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: NY 309453) |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: PA SP024200) | |
| Enumeration Date | 2019-10-12 |
| Last Update Date | 2021-12-21 |