| NPI | 1619120755 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MI 470417854) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: MO 103947) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: IL 309.007583) | |
| Enumeration Date | 2008-11-03 |
| Last Update Date | 2022-08-22 |