| NPI | 1629062567 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: KY 3003666) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: KY 3003666) |
| Enumeration Date | 2005-09-07 |
| Last Update Date | 2020-06-01 |