| NPI | 1619256518 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: AK NURU1339) |
| Additional Taxonomies | 171000000X Military Health Care Provider |
| 363LF0000X Nurse Practitioner, Family (Licence: WI 0039513) | |
| Enumeration Date | 2011-08-09 |
| Last Update Date | 2021-11-05 |