NPI | 1619361078 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MO 2020002138) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: IL 209020918) |
Enumeration Date | 2015-03-24 |
Last Update Date | 2024-10-16 |