| NPI | 1316365414 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: MO XXXXXXXXXX) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: MO XXXXXXXXXXX) |
| Enumeration Date | 2014-04-04 |
| Last Update Date | 2014-05-01 |