| NPI | 1275166126 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NE 113061) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: IA A162560) |
| 363LF0000X Nurse Practitioner, Family (Licence: NE 113061) | |
| Enumeration Date | 2020-02-19 |
| Last Update Date | 2021-02-24 |