| NPI | 1407201320 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: IL 209014186) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: IL 014104300) |
| Enumeration Date | 2016-04-28 |
| Last Update Date | 2019-04-16 |