| NPI | 1407191554 | 
|---|---|
| Entity Type | Individual | 
| Gender | Female | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX AP122544)  | 
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TX 670846)  | 
| Enumeration Date | 2012-11-30 | 
| Last Update Date | 2014-12-18 |