| NPI | 1487142634 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: PA SP019012) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: PA SP019012) |
| Enumeration Date | 2018-04-24 |
| Last Update Date | 2020-02-21 |