| NPI | 1255020327 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: GA RN236055) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: GA RN236055) |
| 363LF0000X Nurse Practitioner Family (Licence: GA RN236055) | |
| Enumeration Date | 2023-05-04 |
| Last Update Date | 2023-10-19 |