| NPI | 1205067659 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics (Licence: MA RN 235184) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: AL 1-125750) |
| Enumeration Date | 2009-08-03 |
| Last Update Date | 2011-02-07 |