| NPI | 1376810598 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner Adult Health (Licence: MO 2008030659) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: KS 77213) |
| Enumeration Date | 2011-11-17 |
| Last Update Date | 2018-04-06 |