| NPI | 1477931269 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 261Q00000X Clinic/Center (Licence: WY 190032638 A) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: WY 4838) |
| Enumeration Date | 2015-05-12 |
| Last Update Date | 2015-05-12 |