| NPI | 1356957534 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MD R211398) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: PA SP023597) |
| 363LF0000X Nurse Practitioner, Family (Licence: PA SP023597) | |
| Enumeration Date | 2020-09-22 |
| Last Update Date | 2022-08-03 |