| NPI | 1235679887 | 
|---|---|
| Entity Type | Individual | 
| Gender | Female | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: WI 7904)  | 
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: IL 209015698)  | 
| Enumeration Date | 2017-03-01 | 
| Last Update Date | 2021-03-31 |