| NPI | 1235268301 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: VT 0550030895) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: NY 001561) |
| Enumeration Date | 2007-03-05 |
| Last Update Date | 2014-05-06 |