| NPI | 1629632401 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: KY 3017316) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: KY 3017316) |
| 363LF0000X Nurse Practitioner, Family (Licence: IL 209.019341) | |
| Enumeration Date | 2019-04-26 |
| Last Update Date | 2022-04-26 |