| NPI | 1407107840 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: WY 28296.1201) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WY 28296) |
| Enumeration Date | 2012-09-25 |
| Last Update Date | 2015-11-23 |