| NPI | 1306443072 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| 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 | 2025-11-07 |