| NPI | 1366616344 | 
|---|---|
| Entity Type | Individual | 
| Gender | Female | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MS A810661) | 
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TN 13403) | 
| Enumeration Date | 2008-04-21 | 
| Last Update Date | 2019-10-25 |