| NPI | 1568573475 | 
|---|---|
| Entity Type | Individual | 
| Gender | Female | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NM CNP-02454)  | 
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA MA-003143-L)  | 
| 363LF0000X Nurse Practitioner, Family (Licence: PA TP006242B)  | |
| 363LF0000X Nurse Practitioner, Family (Licence: CA 287073-8100)  | |
| 363LF0000X Nurse Practitioner, Family (Licence: MO 070035)  | |
| 363A00000X Physician Assistant (Licence: CA 13745)  | |
| 163W00000X Registered Nurse (Licence: NM 81467)  | |
| Enumeration Date | 2006-08-31 | 
| Last Update Date | 2015-03-15 |