| NPI | 1619374055 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LW0102X Nurse Practitioner, Women's Health (Licence: GA RN240704) |
| Additional Taxonomies | 363LW0102X Nurse Practitioner, Women's Health (Licence: SC 18763) |
| Enumeration Date | 2014-12-01 |
| Last Update Date | 2014-12-19 |