| NPI | 1255055356 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 953594-01) |
| 164W00000X Licensed Practical Nurse (Licence: TN 97121) | |
| Enumeration Date | 2022-10-03 |
| Last Update Date | 2024-11-22 |