| NPI | 1568020469 | 
|---|---|
| Entity Type | Individual | 
| Gender | Female | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TN 26152)  | 
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: VA 0024178664)  | 
| 363LF0000X Nurse Practitioner, Family (Licence: GA RN263038)  | |
| 363LF0000X Nurse Practitioner, Family (Licence: SC 22903)  | |
| Enumeration Date | 2019-06-05 | 
| Last Update Date | 2021-03-01 |