| NPI | 1306896618 | 
|---|---|
| Entity Type | Individual | 
| Gender | Female | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: VA 0024091304) | 
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MD AC000862) | 
| Enumeration Date | 2006-05-10 | 
| Last Update Date | 2021-07-26 |