| NPI | 1255460697 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MI 4704219437) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: MI 4704219437) |
| Enumeration Date | 2007-03-03 |
| Last Update Date | 2020-12-15 |