| NPI | 1629549159 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MI 4704267084) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: KY 3016157) |
| 363L00000X Nurse Practitioner (Licence: OR 202104987RN) | |
| Enumeration Date | 2018-12-10 |
| Last Update Date | 2022-10-26 |