| NPI | 1386128395 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 164W00000X Licensed Practical Nurse (Licence: WV 35119) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: PA PN250764L) |
| 164W00000X Licensed Practical Nurse (Licence: MD LP54125) | |
| Enumeration Date | 2018-09-17 |
| Last Update Date | 2018-09-17 |