| NPI | 1285129973 | 
|---|---|
| Entity Type | Individual | 
| Gender | Female | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics (Licence: GA RN183848) | 
| Additional Taxonomies | 208000000X Pediatrics (Licence: GA RN183848) | 
| Enumeration Date | 2018-06-26 | 
| Last Update Date | 2019-01-07 |