| NPI | 1558635565 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: OK R 0112639) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: TX AT4593) |
| Enumeration Date | 2012-03-08 |
| Last Update Date | 2016-01-26 |