| NPI | 1376780700 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0200X Nurse Practitioner Pediatrics (Licence: MO 107871) |
| Additional Taxonomies | 363LP0200X Nurse Practitioner Pediatrics (Licence: KS 46280) |
| Enumeration Date | 2009-01-07 |
| Last Update Date | 2009-01-07 |