| NPI | 1366957920 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: KY 3011833) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: KY 1119292) |
| Enumeration Date | 2017-12-05 |
| Last Update Date | 2017-12-05 |