| NPI | 1265074454 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: AK 179531) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: OR 201909053NP-PP) |
| 363LF0000X Nurse Practitioner, Family (Licence: ID 62702) | |
| Enumeration Date | 2019-10-09 |
| Last Update Date | 2025-01-14 |