| NPI | 1629355813 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MI 4704229883) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MI 4704229883) |
| Enumeration Date | 2011-11-16 |
| Last Update Date | 2015-08-18 |