| NPI | 1215987318 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MD R140445) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: NY 339007) |
| 363LF0000X Nurse Practitioner Family (Licence: MD R140445) | |
| Enumeration Date | 2006-05-11 |
| Last Update Date | 2019-04-24 |