| NPI | 1548480460 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 261QS1000X Clinic/Center Student Health (Licence: WI 63045-030) |
| Additional Taxonomies | 363LP0200X Nurse Practitioner Pediatrics (Licence: WI 638-033) |
| Enumeration Date | 2007-04-26 |
| Last Update Date | 2007-11-08 |