| NPI | 1235536210 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NC 5007339) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: NC 203266) |
| 363LF0000X Nurse Practitioner, Family (Licence: NC 5007339) | |
| Enumeration Date | 2014-11-19 |
| Last Update Date | 2022-01-10 |