| NPI | 1235802976 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: WI 11397) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MI 4704314169) |
| Enumeration Date | 2021-07-28 |
| Last Update Date | 2023-05-01 |