| NPI | 1629658570 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MD R205686) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: VA 0024181249) |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: MD R205686) | |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: VA 0024181249) | |
| 363LG0600X Nurse Practitioner, Gerontology (Licence: MD R205686) | |
| 363LG0600X Nurse Practitioner, Gerontology (Licence: VA 0024181249) | |
| Enumeration Date | 2021-04-13 |
| Last Update Date | 2021-04-13 |