| NPI | 1629278544 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: KY 300607) |
| Additional Taxonomies | 363LP0200X Nurse Practitioner, Pediatrics (Licence: OH COA.09474-NP) |
| 164W00000X Licensed Practical Nurse (Licence: OH COA.09474-NP) | |
| Enumeration Date | 2007-07-19 |
| Last Update Date | 2016-10-07 |