| NPI | 1417064023 |
|---|---|
| Doing Business As | |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: WI 73954-030) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: WI 1651-033) |
| Enumeration Date | 2006-08-23 |
| Last Update Date | 2007-07-08 |