| NPI | 1396035382 | 
|---|---|
| Entity Type | Individual | 
| Gender | Female | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CT 4637) | 
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: CT 4637) | 
| Enumeration Date | 2011-04-12 | 
| Last Update Date | 2017-05-03 |