| NPI | 1336743582 | 
|---|---|
| Entity Type | Individual | 
| Gender | Female | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL 11030849) | 
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MI 4704294673) | 
| Enumeration Date | 2020-11-29 | 
| Last Update Date | 2024-05-23 |