| NPI | 1508810888 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: GA RN124766) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: GA RN124766) |
| 363A00000X Physician Assistant (Licence: GA RN124766) | |
| Enumeration Date | 2006-05-20 |
| Last Update Date | 2010-10-06 |