| NPI | 1528628567 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NC 5015139) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: UT 11443278-4405) |
| 363L00000X Nurse Practitioner (Licence: ID 61792) | |
| Enumeration Date | 2019-06-20 |
| Last Update Date | 2022-12-15 |