| NPI | 1568963635 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 164W00000X Licensed Practical Nurse (Licence: PA pn270911) |
| Additional Taxonomies | 261QM3000X Clinic/Center, Medically Fragile Infants and Children Day Care |
| Enumeration Date | 2018-02-23 |
| Last Update Date | 2018-02-23 |