| NPI | 1568883734 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics (Licence: MA RN191241) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MO 2005004092) |
| 363LP0200X Nurse Practitioner, Pediatrics (Licence: MO 2005004092) | |
| Enumeration Date | 2013-12-13 |
| Last Update Date | 2020-02-05 |