| NPI | 1205225349 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: KS 76655) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MO 2015000862) |
| Enumeration Date | 2015-01-13 |
| Last Update Date | 2015-01-13 |