| NPI | 1629857982 | 
|---|---|
| Entity Type | Individual | 
| Gender | Female | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL 11028788) | 
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: FL APRN11028788) | 
| Enumeration Date | 2023-09-26 | 
| Last Update Date | 2025-06-20 |