| NPI | 1629811625 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: SC 29017) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: SC 277005) |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: SC G29017) | |
| Enumeration Date | 2024-06-17 |
| Last Update Date | 2025-10-17 |