| NPI | 1447766126 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MI 4704293364) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MI 4704293364NSA17497) |
| 363LP0200X Nurse Practitioner, Pediatrics (Licence: MI 4704293364NSA17497) | |
| Enumeration Date | 2017-12-18 |
| Last Update Date | 2018-12-28 |