| NPI | 1245637818 | 
|---|---|
| Entity Type | Individual | 
| Gender | Female | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: VA 0024172203)  | 
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: VA 0024172203)  | 
| Enumeration Date | 2014-11-26 | 
| Last Update Date | 2018-06-28 |