| NPI | 1356972954 | 
|---|---|
| Entity Type | Individual | 
| Gender | Female | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: VA 0024178753) | 
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TN 27017) | 
| Enumeration Date | 2020-02-01 | 
| Last Update Date | 2020-07-16 |