| NPI | 1306126917 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NC 5013320) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: TN 22584) |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: VA 0024169430) | |
| Enumeration Date | 2011-08-26 |
| Last Update Date | 2021-09-10 |