| NPI | 1619968542 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: KY 3004688) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: KY 4688P) |
| Enumeration Date | 2005-10-31 |
| Last Update Date | 2021-04-13 |