| NPI | 1629261342 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: SC 18163) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: KY 5286P) |
| Enumeration Date | 2007-08-27 |
| Last Update Date | 2015-07-15 |