| NPI | 1568411072 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NC 5009318) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MO 149036) |
| 363L00000X Nurse Practitioner (Licence: IL 209-000241) | |
| Enumeration Date | 2006-05-10 |
| Last Update Date | 2018-04-17 |