| NPI | 1508155169 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics (Licence: NC 5007441) |
| Additional Taxonomies | 363LP0200X Nurse Practitioner, Pediatrics (Licence: OH 12286-NP) |
| Enumeration Date | 2011-04-05 |
| Last Update Date | 2015-02-02 |