| NPI | 1619479888 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: LA 123456) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: LA 123456) |
| Enumeration Date | 2018-03-05 |
| Last Update Date | 2018-03-05 |