| NPI | 1578771747 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics (Licence: VA 0024170259) |
| Additional Taxonomies | 363LP0200X Nurse Practitioner, Pediatrics (Licence: MA 236844) |
| 363L00000X Nurse Practitioner (Licence: SC 17579) | |
| Enumeration Date | 2007-05-19 |
| Last Update Date | 2012-09-04 |