| NPI | 1568931962 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: SC 21238) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: VA 0024175789) |
| 363LF0000X Nurse Practitioner, Family (Licence: NY 344839) | |
| Enumeration Date | 2018-11-15 |
| Last Update Date | 2019-09-24 |