| NPI | 1477919256 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-06140) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 001006140) |
| 261QM1300X Clinic/Center, Multi-Specialty | |
| 261QP2300X Clinic/Center, Primary Care | |
| 261QU0200X Clinic/Center, Urgent Care | |
| 363AM0700X Physician Assistant, Medical | |
| Enumeration Date | 2016-01-08 |
| Last Update Date | 2021-02-25 |