| NPI | 1225622855 | 
|---|---|
| Entity Type | Individual | 
| Gender | Female | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: WA N361156950) | 
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX AP145417) | 
| Enumeration Date | 2021-02-24 | 
| Last Update Date | 2021-10-19 |