| NPI | 1336422021 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MS R880146) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner Adult Health (Licence: MS R880146) |
| 363LF0000X Nurse Practitioner Family (Licence: AL 1-120146) | |
| Enumeration Date | 2011-09-20 |
| Last Update Date | 2015-03-24 |