| NPI | 1215095765 | 
|---|---|
| Entity Type | Individual | 
| Gender | Female | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: MA 142749) | 
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: MA 142749) | 
| Enumeration Date | 2006-12-05 | 
| Last Update Date | 2013-03-06 |