| NPI | 1508318148 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: IL 209019478) |
| Additional Taxonomies | 305S00000X Point of Service |
| 363LF0000X Nurse Practitioner, Family (Licence: MI 4704312678) | |
| Enumeration Date | 2016-10-31 |
| Last Update Date | 2022-03-18 |