| NPI | 1427609791 | 
|---|---|
| Entity Type | Individual | 
| Gender | Female | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: FL 11013723) | 
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL 9268064) | 
| 363LF0000X Nurse Practitioner, Family (Licence: FL 11013723) | |
| Enumeration Date | 2019-09-26 | 
| Last Update Date | 2021-12-14 |