| NPI | 1508136391 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: IN 71013251A) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: NC 2427) |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: WY 058) | |
| Enumeration Date | 2012-01-10 |
| Last Update Date | 2023-05-23 |