| NPI | 1609501030 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11019491) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL RN9597059) |
| Enumeration Date | 2022-07-20 |
| Last Update Date | 2023-01-12 |