| NPI | 1457865966 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: GA RN276934) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CO APN.0993448-NP) |
| 363AM0700X Physician Assistant, Medical (Licence: NY 350774) | |
| Enumeration Date | 2017-11-20 |
| Last Update Date | 2023-07-22 |