| NPI | 1619962826 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics (Licence: OH RN149235) |
| Additional Taxonomies | 363LP0200X Nurse Practitioner, Pediatrics (Licence: OH NP00066) |
| 363LP0200X Nurse Practitioner, Pediatrics (Licence: OH CTP00066Rx) | |
| 363LP0200X Nurse Practitioner, Pediatrics (Licence: MI 4704139413) | |
| 363LP0200X Nurse Practitioner, Pediatrics (Licence: MI 1493086) | |
| 363LP0200X Nurse Practitioner, Pediatrics (Licence: MI 1492748) | |
| Enumeration Date | 2005-09-14 |
| Last Update Date | 2012-07-31 |