| NPI | 1407943004 | 
|---|---|
| Entity Type | Individual | 
| Gender | Female | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NY 340493)  | 
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: NY 303581)  | 
| Enumeration Date | 2006-10-06 | 
| Last Update Date | 2021-05-20 |