NPI | 1306443072 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11025578) |
Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: IL 209020965) |
363L00000X Nurse Practitioner (Licence: IL 209020965) | |
Enumeration Date | 2020-10-06 |
Last Update Date | 2023-05-01 |