| NPI | 1609013226 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 164W00000X Licensed Practical Nurse (Licence: MS R887063) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: AL F1008041) |
| Enumeration Date | 2009-01-20 |
| Last Update Date | 2012-01-13 |