| NPI | 1275044224 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty (Licence: MD R197536) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: MD r197336) |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: PA SP019998) | |
| Enumeration Date | 2017-10-17 |
| Last Update Date | 2022-01-04 |