| NPI | 1609014406 | 
|---|---|
| Entity Type | Individual | 
| Gender | Female | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11002041) | 
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NC 20088005525) | 
| 363LF0000X Nurse Practitioner, Family (Licence: TN 14978) | |
| Enumeration Date | 2009-02-02 | 
| Last Update Date | 2020-08-11 |