| NPI | 1619677101 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 261QU0200X Clinic/Center, Urgent Care |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: OH 025609) |
| 363LF0000X Nurse Practitioner, Family (Licence: MI 4704209716) | |
| Enumeration Date | 2023-03-06 |
| Last Update Date | 2023-03-06 |