NPI | 1396365102 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics (Licence: IL 209025098) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: IL 041429321) |
Enumeration Date | 2020-04-22 |
Last Update Date | 2022-09-01 |