| NPI | 1376053678 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: SD CP001524) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NY 342333) |
| Enumeration Date | 2017-10-02 |
| Last Update Date | 2019-09-18 |