NPI | 1508464363 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OK M0109415) |
Additional Taxonomies | 207QA0000X Family Medicine, Adolescent Medicine (Licence: OK F09201316) |
363L00000X Nurse Practitioner (Licence: TX 1017289) | |
Enumeration Date | 2020-10-14 |
Last Update Date | 2025-08-05 |