| NPI | 1508101312 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: GA RN135072) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: TN 17049) |
| Enumeration Date | 2012-12-05 |
| Last Update Date | 2020-03-13 |