| NPI | 1215115357 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics (Licence: UT 5039155-4405) |
| Additional Taxonomies | 363LP0200X Nurse Practitioner, Pediatrics (Licence: SD CP000562) |
| Enumeration Date | 2008-01-31 |
| Last Update Date | 2016-06-16 |