| NPI | 1265900468 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: KS 53-78469) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: KS 78469) |
| 363LP2300X Nurse Practitioner, Primary Care (Licence: KS 53-78469) | |
| Enumeration Date | 2018-11-06 |
| Last Update Date | 2020-05-22 |