| NPI | 1609422419 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: WV 103927) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WV 69841) |
| Enumeration Date | 2019-08-16 |
| Last Update Date | 2019-08-16 |