| NPI | 1265779201 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: ME CNP121103) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MA 2269003) |
| Enumeration Date | 2013-01-10 |
| Last Update Date | 2016-05-18 |