| NPI | 1417965963 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0200X Nurse Practitioner Pediatrics (Licence: OR 099006977N2) |
| Additional Taxonomies | 363LP0200X Nurse Practitioner Pediatrics (Licence: OR 099006977RN) |
| Enumeration Date | 2006-08-03 |
| Last Update Date | 2007-07-20 |