| NPI | 1609362961 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: WV 106709) |
| Additional Taxonomies | 363LP0200X Nurse Practitioner Pediatrics (Licence: KY 3012466) |
| Enumeration Date | 2018-07-10 |
| Last Update Date | 2022-03-04 |