| NPI | 1275569188 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NC 123) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NY 332978) |
| 363LF0000X Nurse Practitioner, Family (Licence: MA 185772) | |
| Enumeration Date | 2006-06-23 |
| Last Update Date | 2016-10-07 |