| NPI | 1316929144 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MI 4704139048) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: WI 974033) |
| Enumeration Date | 2005-11-17 |
| Last Update Date | 2011-09-12 |