| NPI | 1417514712 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NM 57115) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: MO 2019014886) |
| 363L00000X Nurse Practitioner (Licence: NY 345173) | |
| Enumeration Date | 2019-05-22 |
| Last Update Date | 2022-11-03 |