| NPI | 1609974591 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NC 5002289) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: NC 005002289) |
| 363LF0000X Nurse Practitioner, Family (Licence: NC 2006009404) | |
| Enumeration Date | 2006-09-21 |
| Last Update Date | 2020-10-21 |