| NPI | 1417932104 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: SC 2049) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: SC R81025) |
| Enumeration Date | 2005-12-14 |
| Last Update Date | 2015-07-09 |