| NPI | 1457810558 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Additional Taxonomies | 164X00000X Licensed Vocational Nurse (Licence: TX 346620) |
| Enumeration Date | 2019-03-18 |
| Last Update Date | 2019-03-18 |