| NPI | 1629319363 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: KS 150848) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: MO 2013004414) |
| Enumeration Date | 2013-03-05 |
| Last Update Date | 2015-04-20 |