| NPI | 1588272462 | 
|---|---|
| Entity Type | Individual | 
| Gender | Female | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NC 5013419)  | 
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NC F10181582)  | 
| Enumeration Date | 2020-07-16 | 
| Last Update Date | 2020-08-27 |