| NPI | 1578099800 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: IL 209.017056) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: IL 041.389386) |
| Enumeration Date | 2017-05-05 |
| Last Update Date | 2021-11-21 |