| NPI | 1376963801 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: WY 22690.1324) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: WY 226901324) |
| Enumeration Date | 2014-04-23 |
| Last Update Date | 2020-02-09 |