| NPI | 1306243993 | 
|---|---|
| Entity Type | Individual | 
| Gender | Female | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: ID NP1509A)  | 
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: ID N-37560)  | 
| Enumeration Date | 2014-11-25 | 
| Last Update Date | 2021-03-17 |