| NPI | 1417116187 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: KS 1489341022) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MO 151386) |
| Enumeration Date | 2008-06-06 |
| Last Update Date | 2010-09-13 |