| NPI | 1548762826 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: VA 0001241460) |
| Enumeration Date | 2018-03-02 |
| Last Update Date | 2019-03-22 |