| NPI | 1215427679 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OH APRN.CNP.022490) |
| Additional Taxonomies | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) (Licence: OH APRN.CNP.022490) |
| Enumeration Date | 2018-05-11 |
| Last Update Date | 2019-12-21 |