| NPI | 1235659665 | 
|---|---|
| Entity Type | Individual | 
| Gender | Female | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MO 2017020151)  | 
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: KS 77713)  | 
| Enumeration Date | 2017-06-27 | 
| Last Update Date | 2018-06-14 |