| NPI | 1619727112 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP2300X Nurse Practitioner Primary Care (Licence: MI 4704339537) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MI 4704339537) |
| Enumeration Date | 2024-03-26 |
| Last Update Date | 2024-05-21 |