| NPI | 1225630353 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: FL 11009717) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: FL 11009717) |
| Enumeration Date | 2020-11-13 |
| Last Update Date | 2022-01-12 |