| NPI | 1508204561 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NY 320097) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 671424) |
| 363LC1500X Nurse Practitioner, Community Health (Licence: NY 320097) | |
| Enumeration Date | 2013-06-11 |
| Last Update Date | 2019-09-18 |