| NPI | 1386420966 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics (Licence: TN 36415) |
| Additional Taxonomies | 363LP0200X Nurse Practitioner, Pediatrics (Licence: MI 4704251278) |
| 363L00000X Nurse Practitioner (Licence: MI 4704251278) | |
| Enumeration Date | 2023-09-07 |
| Last Update Date | 2024-08-13 |