| NPI | 1235677550 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MA 201523) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MA 201523RN) |
| Enumeration Date | 2017-02-07 |
| Last Update Date | 2019-01-02 |