| NPI | 1558359109 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner Primary Care (Licence: AZ AP4518) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: WI 1440) |
| 363LF0000X Nurse Practitioner Family (Licence: TN APN 12048) | |
| Enumeration Date | 2005-10-07 |
| Last Update Date | 2020-05-05 |