| NPI | 1285109678 | 
|---|---|
| Entity Type | Individual | 
| Gender | Female | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MO 2025037770) | 
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: GA RN222785) | 
| Enumeration Date | 2018-10-11 | 
| Last Update Date | 2025-09-24 |