| NPI | 1396267043 | 
|---|---|
| Entity Type | Individual | 
| Gender | Female | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CA 95025249) | 
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NY 343419) | 
| Enumeration Date | 2017-07-14 | 
| Last Update Date | 2024-08-13 |