| NPI | 1487030748 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 261QM2500X Clinic/Center, Medical Specialty (Licence: CT 6192) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TX 1211660) |
| Enumeration Date | 2015-08-09 |
| Last Update Date | 2026-08-22 |