| NPI | 1396275582 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MI 4704293510) |
| Additional Taxonomies | 163WP0200X Registered Nurse, Pediatrics (Licence: MI 4704293510) |
| 363LP0200X Nurse Practitioner, Pediatrics (Licence: WA AP60810818) | |
| 363LP0200X Nurse Practitioner, Pediatrics (Licence: MI 4704293510) | |
| Enumeration Date | 2017-06-19 |
| Last Update Date | 2021-07-13 |