| NPI | 1255691168 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: VA 0024169989) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: VA 0001189983) |
| Enumeration Date | 2012-05-24 |
| Last Update Date | 2014-11-07 |