| NPI | 1629055736 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CT 12.007315) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MA 254081) |
| 363LF0000X Nurse Practitioner, Family (Licence: KY 3007254) | |
| 363LF0000X Nurse Practitioner, Family (Licence: MO 2012029067) | |
| Enumeration Date | 2005-12-29 |
| Last Update Date | 2022-01-27 |