| NPI | 1275982563 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: KY 3010626) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: KY 3010626) |
| 363L00000X Nurse Practitioner (Licence: OH COA 18958 NP-1) | |
| Enumeration Date | 2016-06-07 |
| Last Update Date | 2016-09-08 |