| NPI | 1245246792 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0200X Nurse Practitioner Pediatrics (Licence: OR 000029869RN) |
| Additional Taxonomies | 363LP0200X Nurse Practitioner Pediatrics (Licence: OR 000029869N2) |
| Enumeration Date | 2006-08-01 |
| Last Update Date | 2007-07-12 |