| NPI | 1225564412 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: CT 7024) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: CT 7024) |
| 363L00000X Nurse Practitioner (Licence: CT 7024) | |
| Enumeration Date | 2017-05-07 |
| Last Update Date | 2020-02-25 |