| NPI | 1215717210 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: PA SP028707) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: PA RN651875) |
| Enumeration Date | 2023-10-05 |
| Last Update Date | 2024-01-03 |