| NPI | 1619386562 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MA RN2301813) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: IL 209.011644) |
| Enumeration Date | 2014-08-05 |
| Last Update Date | 2021-03-15 |