| NPI | 1568722304 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP2300X Nurse Practitioner Primary Care (Licence: KY 3007327) |
| Additional Taxonomies | 171W00000X Contractor (Licence: KY 3007327) |
| Enumeration Date | 2012-05-28 |
| Last Update Date | 2012-08-10 |