| NPI | 1396709564 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-05023) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: PA ma052365) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: PA MA052365) | |
| Enumeration Date | 2006-04-14 |
| Last Update Date | 2022-11-10 |