| NPI | 1568701100 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 261QU0200X Clinic/Center, Urgent Care (Licence: SC 18982) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TN 173940) |
| Enumeration Date | 2013-02-01 |
| Last Update Date | 2018-04-27 |