| NPI | 1407591936 | 
|---|---|
| Entity Type | Individual | 
| Gender | Female | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: SC 26355) | 
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: GA RN275649) | 
| Enumeration Date | 2022-04-29 | 
| Last Update Date | 2022-10-25 |