| NPI | 1558070987 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 164W00000X Licensed Practical Nurse (Licence: WV 29801) |
| Additional Taxonomies | 172V00000X Community Health Worker (Licence: WV 29801) |
| Enumeration Date | 2022-11-15 |
| Last Update Date | 2023-08-31 |