| NPI | 1285679647 | 
|---|---|
| Entity Type | Individual | 
| Gender | Female | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: UT 7844136-4405) | 
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MS R865919) | 
| Enumeration Date | 2006-06-19 | 
| Last Update Date | 2017-11-15 |