| NPI | 1609397819 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 164W00000X Licensed Practical Nurse (Licence: MO 2004009490) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: KS 2435967122) |
| Enumeration Date | 2017-06-28 |
| Last Update Date | 2017-06-28 |