| NPI | 1265111207 | 
|---|---|
| Entity Type | Individual | 
| Gender | Female | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: LA 231111) | 
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: TX 1128686) | 
| Enumeration Date | 2023-07-17 | 
| Last Update Date | 2023-07-20 |