| NPI | 1578562997 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: VA 0024165115) |
| Additional Taxonomies | 363LP2300X Nurse Practitioner, Primary Care (Licence: OR 200550004NP) |
| Enumeration Date | 2005-07-18 |
| Last Update Date | 2007-07-08 |