| NPI | 1265066815 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 164W00000X Licensed Practical Nurse (Licence: NC 85936) |
| Additional Taxonomies | 261QP2300X Clinic/Center, Primary Care |
| 320600000X Residential Treatment Facility, Intellectual and/or Developmental Disabilities | |
| Enumeration Date | 2020-02-22 |
| Last Update Date | 2020-10-31 |