| NPI | 1245500420 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: ME CNP121104) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: IL 209.008703) |
| Enumeration Date | 2012-01-05 |
| Last Update Date | 2013-01-30 |