NPI | 1598205338 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: SD CP002240) |
Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: SD 0365) |
2255A2300X Specialist/Technologist, Athletic Trainer (Licence: ND 430-11) | |
363LF0000X Nurse Practitioner, Family (Licence: ND R48736) | |
Enumeration Date | 2017-02-27 |
Last Update Date | 2022-11-30 |