| NPI | 1255841797 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: KY 3011494) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: OH 021400) |
| 363LF0000X Nurse Practitioner, Family (Licence: WV 110523) | |
| Enumeration Date | 2017-10-11 |
| Last Update Date | 2021-09-13 |