| NPI | 1386183622 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 202D00000X (Licence: MT 124572) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner Adult Health (Licence: MT 124572) |
| 261QP2300X Clinic/Center Primary Care (Licence: MT APRN124572) | |
| Enumeration Date | 2017-02-20 |
| Last Update Date | 2024-03-14 |