| NPI | 1245704667 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: AZ 258059) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: ID 64908) |
| 363L00000X Nurse Practitioner (Licence: CO 0001368) | |
| Enumeration Date | 2019-01-18 |
| Last Update Date | 2021-06-22 |