| NPI | 1619570769 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: NE 113847) |
| Additional Taxonomies | 171000000X Military Health Care Provider |
| 363LF0000X Nurse Practitioner Family (Licence: KS 5379705) | |
| 363LF0000X Nurse Practitioner Family (Licence: MO 2021032480) | |
| Enumeration Date | 2020-11-20 |
| Last Update Date | 2023-11-15 |