| NPI | 1417954579 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics (Licence: MT 115529) |
| Additional Taxonomies | 363LP0200X Nurse Practitioner, Pediatrics (Licence: WI 2110) |
| 363LP0200X Nurse Practitioner, Pediatrics (Licence: IA C148849) | |
| Enumeration Date | 2005-07-05 |
| Last Update Date | 2021-05-20 |