| NPI | 1366090292 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0200X Nurse Practitioner Pediatrics (Licence: WV 104193) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: WV 104193) |
| Enumeration Date | 2019-09-04 |
| Last Update Date | 2019-10-03 |