| NPI | 1376055707 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: SC 21321) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC 21321) |
| 363LF0000X Nurse Practitioner Family (Licence: SC 21321) | |
| Enumeration Date | 2017-10-25 |
| Last Update Date | 2017-10-25 |