| NPI | 1487043626 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MI 4704279757) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OR 201241026) |
| 363LF0000X Nurse Practitioner, Family (Licence: OR 201407627NP-PP) | |
| Enumeration Date | 2015-01-12 |
| Last Update Date | 2016-10-21 |