| NPI | 1568654903 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NC 5010373) |
| Additional Taxonomies | 363LP0200X Nurse Practitioner Pediatrics (Licence: MA 250343) |
| 363LP0200X Nurse Practitioner Pediatrics (Licence: IL 209-004496) | |
| 363LP0200X Nurse Practitioner Pediatrics (Licence: NC 286171) | |
| Enumeration Date | 2007-08-09 |
| Last Update Date | 2021-03-16 |