| NPI | 1275167447 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: WV 105701) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: WV 105701) |
| Enumeration Date | 2020-02-26 |
| Last Update Date | 2020-12-07 |