| NPI | 1215943352 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MI 4704123071) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MI 4704123071) |
| 363LF0000X Nurse Practitioner, Family (Licence: WY 33828.1323) | |
| Enumeration Date | 2006-07-31 |
| Last Update Date | 2022-07-21 |