| 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 |