| NPI | 1235765652 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: ID 55408) |
| Additional Taxonomies | 261QP2300X Clinic/Center, Primary Care (Licence: ID 55408) |
| Enumeration Date | 2020-03-17 |
| Last Update Date | 2020-07-31 |