| NPI | 1518772763 | 
|---|---|
| Entity Type | Individual | 
| Gender | Female | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NY 354533) | 
| Additional Taxonomies | 261QU0200X Clinic/Center, Urgent Care | 
| Enumeration Date | 2025-02-12 | 
| Last Update Date | 2025-05-14 |