| NPI | 1205691029 | 
|---|---|
| Entity Type | Individual | 
| Gender | Female | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: TX 1194777) | 
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MA RN2343792) | 
| Enumeration Date | 2024-02-20 | 
| Last Update Date | 2025-09-16 |