| NPI | 1558972364 | 
|---|---|
| Entity Type | Individual | 
| Gender | Female | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: IL 209021186) | 
| Additional Taxonomies | 363LP2300X Nurse Practitioner, Primary Care (Licence: IL 209021186) | 
| Enumeration Date | 2020-08-14 | 
| Last Update Date | 2020-08-28 |