| NPI | 1306254222 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NC 5015241) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: WV 110623) |
| 363LF0000X Nurse Practitioner, Family (Licence: TN 18846) | |
| Enumeration Date | 2014-07-23 |
| Last Update Date | 2022-06-17 |