| NPI | 1417493081 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: WI 7763) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: FL 9264146) |
| 363L00000X Nurse Practitioner (Licence: MN 5193) | |
| Enumeration Date | 2017-01-06 |
| Last Update Date | 2022-01-03 |