| NPI | 1275054157 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: SC 23590) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: GA 181336) |
| 363LA2200X Nurse Practitioner Adult Health (Licence: FL 11015114) | |
| 363LA2200X Nurse Practitioner Adult Health (Licence: SC 23590RX) | |
| 363LA2200X Nurse Practitioner Adult Health (Licence: NY F310059-01) | |
| Enumeration Date | 2017-06-30 |
| Last Update Date | 2023-12-12 |