| NPI | 1508800624 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: WI 86941) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: WI 1842) |
| 363LP2300X Nurse Practitioner, Primary Care (Licence: WI 1842-33) | |
| Enumeration Date | 2006-06-16 |
| Last Update Date | 2018-08-31 |