| NPI | 1194827444 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: GA RN178125NP) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: SC 2757) |
| 363LF0000X Nurse Practitioner, Family (Licence: PA TP005702B) | |
| Enumeration Date | 2006-09-05 |
| Last Update Date | 2009-01-30 |