| NPI | 1285006304 | 
|---|---|
| Entity Type | Individual | 
| Gender | Female | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: VA 0024173302)  | 
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TN 20949)  | 
| 163W00000X Registered Nurse (Licence: VA 0001238139)  | |
| Enumeration Date | 2015-10-28 | 
| Last Update Date | 2016-03-28 |