| NPI | 1558107052 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MI 4704245059) |
| Additional Taxonomies | 207QA0505X Family Medicine, Adult Medicine (Licence: MI 4704245059) |
| Enumeration Date | 2024-07-03 |
| Last Update Date | 2026-06-16 |