| NPI | 1447621693 | 
|---|---|
| Entity Type | Individual | 
| Gender | Female | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: GA RN147041) | 
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: GA 363LA2200X) | 
| 363LG0600X Nurse Practitioner, Gerontology (Licence: GA 363G0600X) | |
| Enumeration Date | 2015-10-14 | 
| Last Update Date | 2023-04-28 |