| NPI | 1609400266 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: IA A163222) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: KS 53-79079-021) |
| 363LF0000X Nurse Practitioner Family (Licence: MO 2020006450) | |
| Enumeration Date | 2020-02-23 |
| Last Update Date | 2021-10-19 |