| NPI | 1396138368 | 
|---|---|
| Entity Type | Individual | 
| Gender | Female | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: GA RN167551)  | 
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: GA F0315251)  | 
| Enumeration Date | 2015-03-13 | 
| Last Update Date | 2018-03-17 |