| NPI | 1417406976 | 
|---|---|
| Entity Type | Individual | 
| Gender | Female | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MA RN2298221) | 
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MA 2298221) | 
| 363LF0000X Nurse Practitioner, Family (Licence: CA 95011726) | |
| Enumeration Date | 2016-09-26 | 
| Last Update Date | 2025-03-17 |